Provider Demographics
NPI:1811141484
Name:SMITH, ANTHONY TYRONE (LMP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TYRONE
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 MARTIN WAY E # B
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5048
Mailing Address - Country:US
Mailing Address - Phone:360-352-8896
Mailing Address - Fax:
Practice Address - Street 1:3773 MARTIN WAY E # B
Practice Address - Street 2:SUITE 106
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5048
Practice Address - Country:US
Practice Address - Phone:360-352-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist