Provider Demographics
NPI:1982907853
Name:SMITH, QUINTEN LEWIS (PTA)
Entity Type:Individual
Prefix:
First Name:QUINTEN
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-8257
Mailing Address - Country:US
Mailing Address - Phone:901-491-2337
Mailing Address - Fax:
Practice Address - Street 1:6564 BARCLAY ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-8257
Practice Address - Country:US
Practice Address - Phone:901-491-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000001996225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant