Individual
JASON MATTHEW SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
47647 CALEO BAY DR STE 130, LA QUINTA, CA 92253-8857
(760) 771-9054
(760) 771-9057
Mailing address
40239 CATANIA CT, INDIO, CA 92203-3814
(714) 470-8146
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT9432
CA
Other
Enumeration date
10/31/2011
Last updated
10/31/2011
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