MEDICARE: SUSAN M SMITH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3476-24	WI

General Provider Information

NPI Number	:	1134166267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M SMITH PT

Provider Business Mailing Address
First Line	:	285 FOREST GROVE DR STE 208
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-3738
Country	:	US
Telephone Number	:	262-799-4090
Fax Number	:	262-799-4093

Provider Business Practice Location Address
First Line	:	285 FOREST GROVE DR STE 208
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-3738
Country	:	US
Telephone Number	:	262-799-4090
Fax Number	:	262-799-4093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/29/2025

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