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General NPI Number Information
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NPI Number | 1043685951
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Entity Type | Individual
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Provider Name | LASHAY SMITH
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Gender | Female
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 2136 STATELINE RD W STE B-C
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1210
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Country | US
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Telephone | 662-582-7706
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Fax |
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Provider Business Mailing Address
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Address Line | 4942 MATTEW DR
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City | HORN LAKE
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State | MS
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Zip | 38637-8713
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Country | US
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Telephone | 662-582-7706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA4152
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License Number State | MS
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