Individual ProviderDiana Jean SmithPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address5632 La Jolla Blvd, La Jolla, CA 92037-7523(858) 454-9355PECOS EnrollmentBased on the most recent information from CMS, provider Diana Jean Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1083948418Provider TypeIndividualFull NameSmith, Diana JeanCredentialMS PTGenderFemaleSole ProprietorNoEnumeration Date10/2/2009Last Updated10/2/2009Contact InformationPractice LocationPractice Address5632 La Jolla Blvd, La Jolla, CA 92037-7523Phone(858) 454-9355Fax(858) 454-9305Mailing LocationMailing Address5632 La Jolla Blvd, La Jolla, CA 92037-7523Phone(858) 454-9355Fax(858) 454-9305Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT13530California