Provider Demographics
NPI:1417040312
Name:SMITH, BARRY TRAVIS (PT, ATC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:TRAVIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 UPPER EAST VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-3824
Mailing Address - Country:US
Mailing Address - Phone:423-533-4002
Mailing Address - Fax:423-533-4002
Practice Address - Street 1:17919 RANKIN AVE STE G
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7040
Practice Address - Country:US
Practice Address - Phone:423-949-7899
Practice Address - Fax:423-949-3416
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006392225100000X
TN00000006342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer