Basic Information
| Provider Information | |||||||||
| NPI: | 1518259118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TOMAS | ||||||||
| MiddleName: | VAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20934 GREENMONT DR | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977022805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086679397 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3155 AVENUE C | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591028109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066568818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2011 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 37607 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | CP014678T | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.