Provider Demographics
NPI:1518957489
Name:SMITH, JAY ARTHUR (PT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ARTHUR
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
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 1789
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1789
Mailing Address - Country:US
Mailing Address - Phone:360-428-6677
Mailing Address - Fax:360-428-7635
Practice Address - Street 1:2226 MARKET ST
Practice Address - Street 2:STE C
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5451
Practice Address - Country:US
Practice Address - Phone:360-428-6677
Practice Address - Fax:360-428-7635
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8343816Medicaid
WAGAB08623Medicare PIN
WAR12736Medicare UPIN