Healthcare Provider Details

I. General information

NPI: 1972188852
Provider Name (Legal Business Name): KATIE ANN SMITHSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ANN HILLIARD PTA

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W DIVISION STREET
EPHRATA WA
98823-1887
US

IV. Provider business mailing address

247 F CIR SE
EPHRATA WA
98823-1946
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-6100
  • Fax: 509-754-6112
Mailing address:
  • Phone: 509-398-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP161139716
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: