Basic Information
| Provider Information | |||||||||
| NPI: | 1609851559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MOLLEE | ||||||||
| MiddleName: | HOPE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5962 LA PLACE COURT | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009294776 | ||||||||
| FaxNumber: | 7609318370 | ||||||||
| Practice Location | |||||||||
| Address1: | 13315 W WASHINGTON BLVD STE 302 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900665145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108232220 | ||||||||
| FaxNumber: | 3108232636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 26640 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.