MEDICARE: SUSAN LIANE SMITH PTA

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	225200000X	Physical Therapy Assistant	9075	TN

General Provider Information

NPI Number	:	1386588135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LIANE SMITH PTA

Provider Business Mailing Address
First Line	:	176 W UNIVERSITY PKWY
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1618
Country	:	US
Telephone Number	:	731-300-4950
Fax Number	:	731-300-4951

Provider Business Practice Location Address
First Line	:	176 W UNIVERSITY PKWY
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1618
Country	:	US
Telephone Number	:	731-300-4950
Fax Number	:	731-300-4951

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ SUSAN LIANE SMITH PTA” Practice Location

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