Provider Demographics
NPI:1033635248
Name:SMITH, TERESA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11214 THORN BIRD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60071-9217
Mailing Address - Country:US
Mailing Address - Phone:847-946-7551
Mailing Address - Fax:
Practice Address - Street 1:11214 THORN BIRD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071-9217
Practice Address - Country:US
Practice Address - Phone:847-946-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist