Provider Demographics
NPI:1134704034
Name:SMOTHERS, MARSHELLA (LMT)
Entity Type:Individual
Prefix:
First Name:MARSHELLA
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54542
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85078-4542
Mailing Address - Country:US
Mailing Address - Phone:480-447-6445
Mailing Address - Fax:
Practice Address - Street 1:17805 N 40TH ST APT 248
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1783
Practice Address - Country:US
Practice Address - Phone:480-447-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist