Provider Demographics
NPI:1275540817
Name:SMITH, JAMES (JIM) EDWARD JR (PT, MBA)
Entity Type:Individual
Prefix:
First Name:JAMES (JIM)
Middle Name:EDWARD
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 PORCH SWING RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4080
Mailing Address - Country:US
Mailing Address - Phone:865-922-3820
Mailing Address - Fax:
Practice Address - Street 1:2319 W EMORY RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3708
Practice Address - Country:US
Practice Address - Phone:865-947-3797
Practice Address - Fax:865-947-3798
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist