Individual
MS. MACKENZIE NICOLE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
815 NW 9TH ST STE 180, CORVALLIS, OR 97330-6173
(541) 768-5157
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62022
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500720322
—
OR
Enumeration date
02/02/2017
Last updated
03/15/2021
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