Healthcare Provider Details

I. General information

NPI: 1528580867
Provider Name (Legal Business Name): AMANDA S SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CHILHOWEE MEDICAL PARK
MARYVILLE TN
37804-5285
US

IV. Provider business mailing address

PO BOX 5209
MARYVILLE TN
37802-5209
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-3400
  • Fax: 865-982-3400
Mailing address:
  • Phone: 865-982-3400
  • Fax: 865-238-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: