Provider Demographics
NPI:1689806184
Name:SMITH, ELEANOR (PT)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9491
Mailing Address - Country:US
Mailing Address - Phone:601-845-8282
Mailing Address - Fax:601-845-8290
Practice Address - Street 1:3000 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9491
Practice Address - Country:US
Practice Address - Phone:601-845-8282
Practice Address - Fax:601-845-8290
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist