Healthcare Provider Details

I. General information

NPI: 1336070473
Provider Name (Legal Business Name): SADIE SMALL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 RIVER RD N
KEIZER OR
97303-4536
US

IV. Provider business mailing address

734 RURAL AVE S UNIT 734
SALEM OR
97302-5269
US

V. Phone/Fax

Practice location:
  • Phone: 971-458-8235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: