Provider Demographics
NPI:1093894933
Name:SMITH, TAMMY W (PT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:WILSON
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:1519 132ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7203
Practice Address - Country:US
Practice Address - Phone:425-337-9556
Practice Address - Fax:425-357-9186
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000039422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2249SMOtherREGENCE BLUE SHIELD
WA8942955OtherL&I CRIME VICTIMS
WA0214813OtherDEPT. OF LABOR & INDUSTRY
WA8376733Medicaid
WA2072SMOtherREGENCE BLUE SHIELD
WA7274SMOtherREGENCE BLUE SHIELD
WA7291528OtherAETNA
WAG8862258Medicare PIN