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Individual
STACEY ROBYN SMALLWOOD
Active
Individual
STACEY ROBYN SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4873
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446652
—
TN
01
—
3156797
BCBS GROUP
TN
05
—
5441432
—
TN
Enumeration date
04/11/2007
Last updated
01/28/2016
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