Basic Information
| Provider Information | |||||||||
| NPI: | 1609400688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITHSON | ||||||||
| FirstName: | ELLIOT | ||||||||
| MiddleName: | VICTOR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT, ATC, EMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 248 SPRING RUN CIR | ||||||||
| Address2: | |||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327795029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074153712 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 955 CARRILLO DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108540529 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2020 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | 554022 | FL | N | Emergency Medical Service Providers | Emergency Medical Technician, Basic | 225100000X | 35555 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2255A2300X | 3532 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225100000X | 298206 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.