Lawrence Lamar Smith
Individual provider Active NPI Physical Therapy Assistant · Mentone, CA
NPI 1104530278 · NPPES record last updated Jan 12, 2023
Key facts
- NPI
- 1104530278
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 5727 (CA)
- Practice address
- 1350 Wabash Ave
Mentone, CA 92359-1124 - Phone
- (909) 492-4106
- NPI assigned
- Jan 12, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5727 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5727 | CA | Yes |
Addresses
Primary practice location
1350 Wabash Ave
Mentone, CA 92359-1124
Mailing address
10411 Beryl Ave
Mentone, CA 92359-1295
Phone (909) 492-4106
Other providers in Mentone, CA
- Lindsay Ruston
- Anthony Sanders
- Vineet Kumar Sharma
- Ahmed A Shawakha
- Laurel Elizabeth Slater
- Questley J Smith
- Jennifer Uithoven
- Unica HC, LLC
- Valley Star Behavioral Health, Inc.
- Urmi Vasaiwala
All providers in Mentone, CA · Physical Therapy Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.