MEDICARE: MISS MARIA TERESA SMITH PT

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	PT003833	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942423835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA TERESA SMITH PT

Provider Business Mailing Address
First Line	:	790 OAK TRAIL DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-7502
Country	:	US
Telephone Number	:	770-977-6866
Fax Number	:	770-977-6887

Provider Business Practice Location Address
First Line	:	7440 HIGHWAY 92
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5235
Country	:	US
Telephone Number	:	770-212-2170
Fax Number	:	770-783-8639

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	02/18/2025

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