Provider Demographics
NPI:1093348146
Name:SMITH, SHANNNON BROWN (PTA)
Entity Type:Individual
Prefix:
First Name:SHANNNON
Middle Name:BROWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10233 EVENINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0334
Mailing Address - Country:US
Mailing Address - Phone:901-661-2257
Mailing Address - Fax:
Practice Address - Street 1:7820 WALKING HORSE CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2143
Practice Address - Country:US
Practice Address - Phone:901-752-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant