Provider Demographics
NPI:1942423835
Name:SMITH, MARIA TERESA (PT)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:TERESA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:790 OAK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7502
Mailing Address - Country:US
Mailing Address - Phone:770-977-6866
Mailing Address - Fax:770-977-6887
Practice Address - Street 1:7440 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5235
Practice Address - Country:US
Practice Address - Phone:770-212-2170
Practice Address - Fax:770-783-8639
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00970835FMedicaid
GA000970835AMedicaid
GA00970835GMedicaid