Provider Demographics
NPI:1710419619
Name:SMOKY MOUNTAIN SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-631-3009
Mailing Address - Street 1:90 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-3030
Mailing Address - Country:US
Mailing Address - Phone:828-631-3009
Mailing Address - Fax:828-354-0209
Practice Address - Street 1:90 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-3030
Practice Address - Country:US
Practice Address - Phone:828-550-3923
Practice Address - Fax:828-354-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty