Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1002 | OR |
NPI | 1255698411 |
---|---|
Provider Name | Mr. Eric J Smith |
First Address | Portland, OR 97202-8409 |
Second Address | Portland, OR 97202-8409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 12/04/2012 |