Provider Demographics
NPI:1871543488
Name:SMITH, SANDRA W (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:2412 FALLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4110
Mailing Address - Country:US
Mailing Address - Phone:626-913-2385
Mailing Address - Fax:
Practice Address - Street 1:600 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2361
Practice Address - Country:US
Practice Address - Phone:714-254-7100
Practice Address - Fax:714-254-7104
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 60362251G0304X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics