Individual
DR. KELLY SMOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1043 JACK VEST DRIVE, JOHNSON CITY, TN 37614
(423) 439-4044
Mailing address
1095 CHARTER ROW, JOHNSON CITY, TN 37604-4338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14609
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q086331
—
TN
Enumeration date
07/31/2023
Last updated
01/25/2024
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