Healthcare Provider Details

I. General information

NPI: 1336681303
Provider Name (Legal Business Name): ZOE E SMITH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 3RD ST SE SUITE A
PUYALLUP WA
98372
US

IV. Provider business mailing address

17528 MERIDIAN E SUITE 207
PUYALLUP WA
98375
US

V. Phone/Fax

Practice location:
  • Phone: 253-200-2355
  • Fax: 253-200-2977
Mailing address:
  • Phone: 253-445-9030
  • Fax: 253-445-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60708328
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: