Provider Demographics
NPI:1427271246
Name:SMITH, PERRY HAMILTON (MPT)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:HAMILTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CADILLAC DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5078
Mailing Address - Country:US
Mailing Address - Phone:615-373-5020
Mailing Address - Fax:615-373-5420
Practice Address - Street 1:10 CADILLAC DR
Practice Address - Street 2:SUITE 160
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5078
Practice Address - Country:US
Practice Address - Phone:615-373-5020
Practice Address - Fax:615-373-5420
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050053112251X0800X
TN79432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4173590OtherBCBS
TN3650102Medicare PIN
VAJ757-0002OtherBCBS
TN3650102Medicare PIN