# PRINEVILLE PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497909378
- **Authorized official:** MR. KENNETH WAYNE SMITH P.T. (OWNER)
- **Authorized official phone:** (541) 447-6846

## Contact information

- **Practice address:** 1251 NE ELM ST, SUITE 2A, PRINEVILLE, OR 97754-1206
- **Practice address phone:** (541) 447-6846
- **Practice address fax:** (541) 447-1243
- **Mailing address:** 1251 NE ELM ST, SUITE 2A, PRINEVILLE, OR 97754-1206
- **Mailing address phone:** (541) 447-6846
- **Mailing address fax:** (541) 447-1243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 0963 | OR | Yes |

## Other

- **Enumeration date:** 11/05/2008
- **Last updated:** 11/05/2008