Healthcare Provider Details

I. General information

NPI: 1942507850
Provider Name (Legal Business Name): MEGAN MAYEUX SMITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 US HIGHWAY 411 S
MARYVILLE TN
37801-8634
US

IV. Provider business mailing address

1229 HARRISON GLEN LN
KNOXVILLE TN
37922-5588
US

V. Phone/Fax

Practice location:
  • Phone: 865-238-5338
  • Fax:
Mailing address:
  • Phone: 225-241-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number12006
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: