Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT0000000585 | TN |
NPI | 1124362793 |
---|---|
Provider Name | Helen Smith |
First Address | Medina, TN 38355-9786 |
Second Address | Jackson, TN 38305-6656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 20/11/2012 |