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General NPI Number Information
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NPI Number | 1598849648
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Entity Type | Individual
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Provider Name | JUSTIN SMITH JUSTIN SMITH PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 629 W ELK AVE
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2559
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Country | US
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Telephone | 423-543-0073
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Fax | 423-543-1277
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Provider Business Mailing Address
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Address Line | 109 DONNA AVE
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2818
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Country | US
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Telephone | 423-335-4210
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Fax | 423-543-1277
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7663
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License Number State | TN
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