Provider Demographics
NPI:1679659379
Name:SMATHERS, SHELLEY L (BS PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:SMATHERS
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:5605 100TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2710
Practice Address - Country:US
Practice Address - Phone:253-284-9800
Practice Address - Fax:253-284-9801
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00007185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8298SMOtherREGENCE BLUE SHIELD
WA8936915OtherCRIME VICTIMS
WA160516OtherDEPT OF LABOR & INDUSTRY
WA8337313Medicaid
WAA021OtherTRICARE
WA8298SMOtherREGENCE BLUE SHIELD
WAAB29950Medicare UPIN