Individual
MR. KENNETH W SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1251 NE ELM ST, STE 2-A, PRINEVILLE, OR 97754-1206
(541) 447-6846
(541) 447-1243
Mailing address
1251 NE ELM ST, STE 2-A, PRINEVILLE, OR 97754-1206
(541) 447-6846
(541) 447-1243
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0963
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160010
—
OR
Enumeration date
01/09/2007
Last updated
10/09/2007
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