Provider Demographics
NPI:1598740540
Name:SMITH, LINDA SUE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10220 SW GREENBURG RD
Mailing Address - Street 2:SUITE 201 LINCOLN CTR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5505
Mailing Address - Country:US
Mailing Address - Phone:503-570-3665
Mailing Address - Fax:
Practice Address - Street 1:10220 SW GREENBURG RD
Practice Address - Street 2:SUITE 201 LINCOLN CTR INFINITY REHAB
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5505
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3884225100000X
WAPT00002876225100000X
AZ3315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027904Medicaid
OR133846Medicare PIN