Provider Demographics
NPI:1649256488
Name:SMITH, CHERYL ANNE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANNE
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:12900 NE 180TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5773
Mailing Address - Country:US
Mailing Address - Phone:425-483-4270
Mailing Address - Fax:425-483-4268
Practice Address - Street 1:12900 NE 180TH ST STE 110
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5773
Practice Address - Country:US
Practice Address - Phone:425-483-4270
Practice Address - Fax:425-483-4268
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8333718Medicaid
WAAB21294Medicare PIN