Provider Demographics
NPI:1609313907
Name:SMOAK, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SMOAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WAKEFIELD DR
Mailing Address - Street 2:APT. B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3764
Mailing Address - Country:US
Mailing Address - Phone:704-905-5199
Mailing Address - Fax:
Practice Address - Street 1:280 S BECKFORD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2564
Practice Address - Country:US
Practice Address - Phone:252-438-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist