Provider Demographics
NPI:1952379539
Name:SMITH, JOSEPH JACK (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JACK
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 KELSEY CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4449
Mailing Address - Country:US
Mailing Address - Phone:615-315-9023
Mailing Address - Fax:
Practice Address - Street 1:741 PRESIDENT PL
Practice Address - Street 2:SUITE 130
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6807
Practice Address - Country:US
Practice Address - Phone:615-220-0086
Practice Address - Fax:615-220-1682
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist