Provider Demographics
NPI:1033469523
Name:SMART, DUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:SMART
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N WORTHEN
Mailing Address - Street 2:STE 200
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-665-3156
Mailing Address - Fax:509-665-0414
Practice Address - Street 1:18 N WORTHEN
Practice Address - Street 2:STE 200
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-665-3156
Practice Address - Fax:509-665-0414
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60301019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist