Provider Demographics
NPI:1427208107
Name:SMITH, INGERID B AASE (PT)
Entity type:Individual
Prefix:
First Name:INGERID
Middle Name:B AASE
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 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2535
Practice Address - Street 1:947 VETERANS WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2564
Practice Address - Country:US
Practice Address - Phone:541-504-2350
Practice Address - Fax:541-504-2354
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270943Medicaid
OR270943Medicaid