Healthcare Provider Details

I. General information

NPI: 1811141484
Provider Name (Legal Business Name): ANTHONY TYRONE SMITH CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W HERON ST
ABERDEEN WA
98520-6022
US

IV. Provider business mailing address

421 W STATE ST
ABERDEEN WA
98520-6129
US

V. Phone/Fax

Practice location:
  • Phone: 564-544-1950
  • Fax: 564-544-1938
Mailing address:
  • Phone: 564-544-1950
  • Fax: 564-544-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00024086
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSS.PR.70122834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: