Prineville Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0963 Issued in OR

Legal business name

PRINEVILLE PHYSICAL THERAPY, LLC

Practice address

1251 NE Elm St
Suite 2a
Prineville, OR 97754-1206

Phone

(541) 447-6846

Fax

(541) 447-1243

NPI assigned

Nov 5, 2008

Last updated

Nov 5, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth Wayne Smith, P.T.NPI 1184773954

Title

Owner

Phone

(541) 447-6846

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth W Smith, P.T.

  • Physical Therapist
  • Prineville, OR
  • NPI 1184773954
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1497909378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 NE ELM ST",
            "address_2": "SUITE 2A",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541206",
            "telephone_number": "541-447-6846",
            "fax_number": "541-447-1243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 NE ELM ST",
            "address_2": "SUITE 2A",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541206",
            "telephone_number": "541-447-6846",
            "fax_number": "541-447-1243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINEVILLE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-447-6846",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "0963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Poston, LCPC, LMHC
• Catilyn Bonney Powers
• Robert Prentice, QMHA, PSS
• Charles Price, DO
• Prineville Counseling Center LLC (Prineville Counseling Center)
• Proactive Physical Therapy - Prineville, LLC (Prineville Physical Therapy)
• Susan Puddy, RN
• Melissa Putman, MSW
• Jeff Raaymakers, CAC I, AAS
• Anthony Ramos, DMD

• Physical Therapist in Prineville, OR
• Providers in Prineville, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.