Provider Demographics
NPI:1124362793
Name:SMITH, HELEN (PT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
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 1:143 SPRING CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-9786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 N STAR DR
Practice Address - Street 2:STE. E
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6656
Practice Address - Country:US
Practice Address - Phone:731-410-2260
Practice Address - Fax:731-668-7842
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000005852251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics