Provider Demographics
NPI:1376176867
Name:SMITH, AMY LEIGH ANNE (PT DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 LYONS VIEW PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6471
Mailing Address - Country:US
Mailing Address - Phone:865-588-6358
Mailing Address - Fax:865-909-9949
Practice Address - Street 1:5822 LYONS VIEW PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6471
Practice Address - Country:US
Practice Address - Phone:865-588-6358
Practice Address - Fax:865-909-9949
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12741OtherDEPARTMENT OF HEALTH BOARD OF PHYSICAL THERAPY