Provider Demographics
NPI:1912440553
Name:SMITH, AMBER DAWN (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DAWN
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 1:685 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5300
Mailing Address - Country:US
Mailing Address - Phone:541-223-1312
Mailing Address - Fax:
Practice Address - Street 1:685 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5300
Practice Address - Country:US
Practice Address - Phone:541-223-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4120225100000X
VA2305213385225100000X
WA61489164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist