Doctor Name: | RUSSELL DALE SMITH |
NPI Number: | 1477852580 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | 15176 |
Business Practice Address: | 309 Elm Ave Tillamook, OR - 971413437 |
Business Phone Number: | 5038124435 |
Business Fax Number: | 5038420396 |
Mailing Address: | 6620 Circle Dr, TILLAMOOK |
State: | OR |
Postal Code: | 971413160 |
Phone Number: | 5038124435 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2011 |
NPI Last Update Date: | 01/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 15176 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |