Provider Demographics
NPI:1942018890
Name:SMITH, LELA MCNEW (LMT, RCR)
Entity type:Individual
Prefix:MS
First Name:LELA
Middle Name:MCNEW
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT, RCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SOUTH KINGSTON STREET
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887
Mailing Address - Country:US
Mailing Address - Phone:423-215-7147
Mailing Address - Fax:
Practice Address - Street 1:103 SOUTH KINGSTON STREET
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3788
Practice Address - Country:US
Practice Address - Phone:423-215-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14850225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist