Organization
KENNETH W SMITH PT
Active
Other names
Prineville Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH W SMITH P.T. (OWNER/PHYSICAL THERAPIST)
(541) 447-6846
Entity
Organization
Contact information
Practice address
1251 NE ELM ST STE 2A, PRINEVILLE, OR 97754-3143
(541) 447-6846
(541) 447-1243
Mailing address
1251 NE ELM ST STE 2A, PRINEVILLE, OR 97754-3143
(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
09/19/2007
Last updated
10/10/2007
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