Provider Demographics
NPI:1487855706
Name:SMITH, TERESA C (PT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720A MEDICAL PARK DR
Mailing Address - Street 2:STE 210
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2122
Mailing Address - Country:US
Mailing Address - Phone:228-546-3266
Mailing Address - Fax:228-392-5288
Practice Address - Street 1:1720 MEDICAL PARK DR # A
Practice Address - Street 2:SUITE 210
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2131
Practice Address - Country:US
Practice Address - Phone:228-392-3499
Practice Address - Fax:228-392-5288
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist