Healthcare Provider Details

I. General information

NPI: 1942423835
Provider Name (Legal Business Name): MARIA TERESA SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 HIGHWAY 92
WOODSTOCK GA
30189-5235
US

IV. Provider business mailing address

790 OAK TRAIL DR
MARIETTA GA
30062-7502
US

V. Phone/Fax

Practice location:
  • Phone: 770-212-2170
  • Fax: 770-783-8639
Mailing address:
  • Phone: 770-977-6866
  • Fax: 770-977-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003833
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: