Provider Demographics
NPI:1619183233
Name:SMITH, BONNIE LYNN (ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, PTA
Mailing Address - Street 1:1107 W PEAR AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1074
Mailing Address - Country:US
Mailing Address - Phone:509-697-6439
Mailing Address - Fax:
Practice Address - Street 1:1000 S. 12 AVE.
Practice Address - Street 2:YVCC SHERAR GYMNASIUM
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2521
Practice Address - Country:US
Practice Address - Phone:509-574-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer