Provider Demographics
NPI:1295823722
Name:SMITH, ANDREW E (MS, PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 HARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-8020
Mailing Address - Country:US
Mailing Address - Phone:865-687-4537
Mailing Address - Fax:865-687-5367
Practice Address - Street 1:2704 MINERAL SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1562
Practice Address - Country:US
Practice Address - Phone:865-687-4537
Practice Address - Fax:865-687-5367
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446566Medicaid
TN3123654OtherBCBSTN
TN446566Medicare ID - Type UnspecifiedMEDICARE PART B