Provider Demographics
NPI:1841673993
Name:SMITH, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 MARKET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-4465
Mailing Address - Country:US
Mailing Address - Phone:423-842-9322
Mailing Address - Fax:866-591-0619
Practice Address - Street 1:3312 KEITH ST NW STE 104
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3757
Practice Address - Country:US
Practice Address - Phone:423-842-9322
Practice Address - Fax:866-591-0619
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9939225100000X
GAPT0115102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics