Individual
DELIA A SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3776
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11260502
CAQH IDENTIFICATIO NUMBER
OR
01
—
227906
OMAP
OR
01
—
840221000
REGENCE BLUE CROSS
OR
Enumeration date
01/29/2006
Last updated
12/20/2018
Update your record
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