Healthcare Provider Details

I. General information

NPI: 1386510832
Provider Name (Legal Business Name): JORDAN SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 AVENUE D
SNOHOMISH WA
98290-2744
US

IV. Provider business mailing address

619 89TH AVE SE
LAKE STEVENS WA
98258-6641
US

V. Phone/Fax

Practice location:
  • Phone: 360-563-1020
  • Fax:
Mailing address:
  • Phone: 425-879-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70040712
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: