Provider Demographics
NPI:1689144081
Name:SMYRNOV, ANATOLIY (PT)
Entity Type:Individual
Prefix:MR
First Name:ANATOLIY
Middle Name:
Last Name:SMYRNOV
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PARKER STREET
Mailing Address - Street 2:PO BOX # 4
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357
Mailing Address - Country:US
Mailing Address - Phone:615-686-5547
Mailing Address - Fax:
Practice Address - Street 1:1559 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1316
Practice Address - Country:US
Practice Address - Phone:931-815-4367
Practice Address - Fax:931-815-4630
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist