Provider Demographics
NPI:1760857874
Name:SMITH, KATHERINE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 NE 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5409
Mailing Address - Country:US
Mailing Address - Phone:206-524-5115
Mailing Address - Fax:206-524-2456
Practice Address - Street 1:8630 164TH AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1906
Practice Address - Country:US
Practice Address - Phone:425-658-4980
Practice Address - Fax:425-658-4977
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60554589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8959313Medicare PIN