Healthcare Provider Details

I. General information

NPI: 1447184833
Provider Name (Legal Business Name): TIERNEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N CLARK ST
CHICAGO IL
60614-1768
US

IV. Provider business mailing address

1235 N MARION CT
CHICAGO IL
60622-7580
US

V. Phone/Fax

Practice location:
  • Phone: 773-755-7566
  • Fax:
Mailing address:
  • Phone: 310-692-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.39931
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: