Provider Demographics
NPI:1386796977
Name:SMITH, TERI LEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S ALEXANDER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-8400
Mailing Address - Country:US
Mailing Address - Phone:813-719-1963
Mailing Address - Fax:813-719-1963
Practice Address - Street 1:1003 S ALEXANDER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-8400
Practice Address - Country:US
Practice Address - Phone:813-719-1963
Practice Address - Fax:813-719-1963
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0019085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC8116OtherBCBS