=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891284303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISBETH SMITH MS, LAT, ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2018
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 AMERICAN AVE
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-928-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10315 W PLUM TREE CIR APT 101
-----------------------------------------------------
City | HALES CORNERS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53130-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-374-4354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------