Provider Demographics
NPI:1043337975
Name:SMITH, CARMEN LATONYA (PT)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LATONYA
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 1:8148 COUNTRY MILL CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0508
Mailing Address - Country:US
Mailing Address - Phone:901-624-6050
Mailing Address - Fax:
Practice Address - Street 1:1536 APPLING CARE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4927
Practice Address - Country:US
Practice Address - Phone:901-385-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist