Provider Demographics
NPI:1275540353
Name:SMITH, T ANDY (DPT MTC)
Entity Type:Individual
Prefix:MR
First Name:T
Middle Name:ANDY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT MTC
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:ANDERSON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT MTC
Mailing Address - Street 1:55 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1503
Mailing Address - Country:US
Mailing Address - Phone:706-542-8621
Mailing Address - Fax:706-583-0217
Practice Address - Street 1:55 CARLTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1503
Practice Address - Country:US
Practice Address - Phone:706-542-8621
Practice Address - Fax:706-583-0217
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist