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General NPI Number Information
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NPI Number | 1255527636
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Entity Type | Organization
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Legal Business Name | KENNETH W SMITH PT
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 1251 NE ELM ST STE 2A
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City | PRINEVILLE
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State | OR
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Zip | 97754-3143
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Country | US
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Telephone | 541-447-6846
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Fax | 541-447-1243
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Provider Business Mailing Address
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Address Line | 1251 NE ELM ST STE 2A
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City | PRINEVILLE
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State | OR
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Zip | 97754-3143
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Country | US
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Telephone | 541-447-6846
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Fax | 541-447-1243
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. KENNETH W SMITH
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Credential | P.T.
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Telephone | 541-447-6846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0963
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License Number State | OR
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