Sandra Mae Smith, PHYSICAL THERAPIST A

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160043450 Issued in WA

Practice address

430 Lily Rd. NE
Olympia, WA 98506

Phone

(360) 491-9700

Fax

(360) 923-5330

NPI assigned

Jan 17, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Sandra Mae Fruits Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389916800000",
    "number": "1154743649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 LILY RD. NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-491-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 LILY RD. NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-491-9700",
            "fax_number": "360-923-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SANDRA",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-17",
        "last_updated": "2014-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160043450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "FRUITS",
            "middle_name": "MAE",
            "prefix": "MRS.",
            "credential": "PHYSICAL THERAPIST A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Michele Smith
• Pamela Jean Smith
• Patrick Riley Smith, DO
• Rachel Ann Smith
• Rylee Jean Smith
• Sara Smith, CPC, CCAR
• Theresa Marie Smith
• Tiffaney Rose Smith
• Tyheasha Smith
• Sheila M Smitherman, MD

• Physical Therapy Assistant in Olympia, WA
• Providers in Olympia, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.