Provider Demographics
NPI:1831262963
Name:SMITH, TAMMY WILLIAMS (PT ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:WILLIAMS
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8723 BELFORD VALLEY LANE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-846-7857
Mailing Address - Fax:
Practice Address - Street 1:820 S BOYLAN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2176
Practice Address - Country:US
Practice Address - Phone:919-733-5576
Practice Address - Fax:919-733-7365
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1755225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant