Provider Demographics
NPI:1386391852
Name:SMURTHWAITE, CHAD (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SMURTHWAITE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 NW JOY AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5883
Mailing Address - Country:US
Mailing Address - Phone:503-896-0882
Mailing Address - Fax:
Practice Address - Street 1:9115 SW OLESON RD STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6877
Practice Address - Country:US
Practice Address - Phone:503-245-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist