Basic Information
| Provider Information | |||||||||
| NPI: | 1932406501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | FIONA | ||||||||
| MiddleName: | CUMMINS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15490 BOSTON PKWY APT 104 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503254690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418210153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 E HICKMAN RD | ||||||||
| Address2: | |||||||||
| City: | WAUKEE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502635022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159876267 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2011 | ||||||||
| LastUpdateDate: | 01/29/2016 | ||||||||
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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 | 004688 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.