Provider Demographics
NPI:1942507850
Name:MAYEUX SMITH, MEGAN (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MAYEUX SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 HARRISON GLEN LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5588
Mailing Address - Country:US
Mailing Address - Phone:225-241-2445
Mailing Address - Fax:
Practice Address - Street 1:2317 US HIGHWAY 411 S
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-8634
Practice Address - Country:US
Practice Address - Phone:865-238-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN120062251G0304X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics