Provider Demographics
NPI:1740247147
Name:SMITH, ZANE ARTHUR (MPT)
Entity type:Individual
Prefix:MR
First Name:ZANE
Middle Name:ARTHUR
Last Name:SMITH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 NE 112TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5104
Mailing Address - Country:US
Mailing Address - Phone:360-567-2002
Mailing Address - Fax:360-567-2005
Practice Address - Street 1:916 NE 112TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5104
Practice Address - Country:US
Practice Address - Phone:360-567-2002
Practice Address - Fax:360-567-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8868884Medicare UPIN
OR117737Medicare ID - Type Unspecified