Provider Demographics
NPI:1013078112
Name:SMITH, RAEMA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:RAEMA
Middle Name:LYNN
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 1:34820 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9629
Mailing Address - Country:US
Mailing Address - Phone:541-744-9657
Mailing Address - Fax:
Practice Address - Street 1:600 DALE KUNI RD
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9874
Practice Address - Country:US
Practice Address - Phone:541-895-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist