Provider Demographics
NPI:1902823453
Name:THE SMITH CLINIC FOR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:THE SMITH CLINIC FOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-756-1650
Mailing Address - Street 1:8110 CORDOVA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0521
Mailing Address - Country:US
Mailing Address - Phone:901-756-1650
Mailing Address - Fax:901-756-1396
Practice Address - Street 1:8110 CORDOVA RD STE 107
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0521
Practice Address - Country:US
Practice Address - Phone:901-756-1650
Practice Address - Fax:901-756-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650855Medicare PIN