Healthcare Provider Details

I. General information

NPI: 1922972991
Provider Name (Legal Business Name): AMY SMELKO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 POTTERY AVE STE 100
PORT ORCHARD WA
98366-2518
US

IV. Provider business mailing address

4975 PINE ST
LA MESA CA
91942-9315
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-9090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT70023173
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: