Provider Demographics
NPI:1902177215
Name:SMITH, TANYA ELAINE (PT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6505
Mailing Address - Country:US
Mailing Address - Phone:580-223-3383
Mailing Address - Fax:580-223-6696
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6505
Practice Address - Country:US
Practice Address - Phone:580-223-3383
Practice Address - Fax:580-223-6696
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist