Healthcare Provider Details

I. General information

NPI: 1376351015
Provider Name (Legal Business Name): SMITH PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SW 4TH ST STE 185
CORVALLIS OR
97333-4654
US

IV. Provider business mailing address

301 SW 4TH ST STE 185
CORVALLIS OR
97333-4654
US

V. Phone/Fax

Practice location:
  • Phone: 541-829-3765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARA SMITH
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 541-829-3765