Provider Demographics
NPI:1629411780
Name:SMITH, JOSHUA JOE (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JOE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 CALVIN WILSON RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL
Mailing Address - State:KY
Mailing Address - Zip Code:42049-8637
Mailing Address - Country:US
Mailing Address - Phone:270-492-8333
Mailing Address - Fax:
Practice Address - Street 1:800 VOLUNTEER DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5472
Practice Address - Country:US
Practice Address - Phone:731-642-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004869225200000X
KYA02598225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant