Provider Demographics
NPI:1134434897
Name:SMITH, JENNIFER TYNETTE (DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TYNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:TYNETTE
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3455 PEACHTREE PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9104
Practice Address - Country:US
Practice Address - Phone:678-473-1081
Practice Address - Fax:678-473-1082
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist