MEDICARE: MRS. JENNIFER SMITH MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0000006617	TN

General Provider Information

NPI Number	:	1073974713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SMITH MPT

Provider Business Mailing Address
First Line	:	8458 PETTUS RD
Second Line	:
City	:	EAGLEVILLE
State	:	TN
Zip	:	37060-9107
Country	:	US
Telephone Number	:	615-310-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 ROBERT ROSE DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37129-6373
Country	:	US
Telephone Number	:	615-310-2466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	03/08/2016

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