Provider Demographics
NPI:1902058902
Name:SMITH, HELEN R (BA, PTA)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRADING BAY RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7786
Mailing Address - Country:US
Mailing Address - Phone:907-252-0594
Mailing Address - Fax:
Practice Address - Street 1:117 HAIDA DR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7953
Practice Address - Country:US
Practice Address - Phone:907-252-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101226225700000X
AK1582225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101226OtherALASKA STATE MASSAGE THERAPY BOARD
AK1582OtherALASKA STATE PHYSICAL THERAPY BOARD
AKPTA008 1029862Medicaid