Provider Demographics
NPI:1588635536
Name:SMITH, DELIA A (PT)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3333
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0312
Mailing Address - Country:US
Mailing Address - Phone:541-621-9373
Mailing Address - Fax:866-746-1959
Practice Address - Street 1:24 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7338
Practice Address - Country:US
Practice Address - Phone:541-621-9373
Practice Address - Fax:866-746-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840221000OtherREGENCE BLUE CROSS
OR227906OtherOMAP
OR11260502OtherCAQH IDENTIFICATIO NUMBER
OR11260502OtherCAQH IDENTIFICATIO NUMBER
OR227906OtherOMAP