Provider Demographics
NPI:1629114368
Name:SMITH, PAMELA LYNN (PHYSICAL THERAPY AS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 FLAT RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-8519
Mailing Address - Country:US
Mailing Address - Phone:615-824-8487
Mailing Address - Fax:
Practice Address - Street 1:NHC SPRINGFIELD
Practice Address - Street 2:608 8TH AVE EAST
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-384-8453
Practice Address - Fax:615-384-9350
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000000267225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant