Healthcare Provider Details

I. General information

NPI: 1609188564
Provider Name (Legal Business Name): HEATHER ASHLEY SMITH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14208 107TH AVENUE CT E
PUYALLUP WA
98374-3827
US

IV. Provider business mailing address

14208 107TH AVENUE CT E
PUYALLUP WA
98374-3827
US

V. Phone/Fax

Practice location:
  • Phone: 253-961-2044
  • Fax:
Mailing address:
  • Phone: 253-961-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60160190
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: