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NPI Code Detail

MEDICARE: ALISA D. SMITH LPT

MEDICARE: ALISA D. SMITH LPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT013546OH
2225100000XPhysical Therapist9585NC
3225100000XPhysical Therapist12134TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112134OTHERTNPHYSICAL THERAPIST

General Provider Information

NPI Number : 1659357697
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISA D. SMITH LPT
Provider Business Mailing Address
First Line : 2410 SUSANNAH ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-1748
Country : US
Telephone Number : 423-282-9011
Fax Number :
Provider Business Practice Location Address
First Line : 2410 SUSANNAH ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-1748
Country : US
Telephone Number : 423-282-9011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 01/28/2021

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