Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5011 | OR |
NPI | 1730718768 |
---|---|
Provider Name | Marvin C Smith |
First Address | Beaverton, OR 97078-4343 |
Second Address | Beaverton, OR 97006-6011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2020 |
Last Update Date | 02/04/2020 |