Individual provider Active NPI

Justin Smith, JUSTIN SMITH PT, DPT

  • Physical Therapist
  • Elizabethton, TN
National Provider Identifier
1598849648
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7663 Issued in TN
Practice address
629 W Elk Ave
Elizabethton, TN 37643-2559
Phone
(423) 543-0073
Fax
(423) 543-1277
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 7663 TN Primary

Addresses

Primary practice location

629 W Elk Ave
Elizabethton, TN 37643-2559

Mailing address

109 Donna Ave
Elizabethton, TN 37643-2818
Phone (423) 335-4210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160705001592 TN Practitioner - Physical Therapist in Private Practice 9931491321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Therapy Services PAGroup PAC ID 0840265591, 3 clinicians

Practice addresses (Care Compare)

1975 W Elk Ave
Suite 1
Elizabethton, TN 37643-3787
Phone (423) 543-0073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7663TNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy Services, P.a. Physical Therapist CurrentSince May 3, 2016 Accepting new patients

Locations

629 W Elk Ave
Elizabethton, TN 37643
Phone (423) 543-0073

1975 W Elk Ave
Ste 1
Elizabethton, TN 37643
Phone (423) 543-0073

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598849648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 DONNA AVE",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432818",
            "telephone_number": "423-335-4210",
            "fax_number": "423-543-1277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 W ELK AVE",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432559",
            "telephone_number": "423-543-0073",
            "fax_number": "423-543-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "JUSTIN SMITH PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "7663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.