Individual
JONATHAN THOMAS SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2645 NORTH 17TH ST, COOS BAY, OR 97420
(541) 266-3658
Mailing address
1369 CALIFORNIA AVE, COOS BAY, OR 97420-1009
(315) 794-8530
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
T 60243
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T60243
TEMP LICENSE NUMBER
OR
Enumeration date
06/19/2013
Last updated
06/19/2013
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