Basic Information
| Provider Information | |||||||||
| NPI: | 1275540817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JAMES (JIM) | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PT, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2813 PORCH SWING RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379384080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659223820 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2319 W EMORY RD | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378493708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659473797 | ||||||||
| FaxNumber: | 8659473798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0000005351 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.