Provider Demographics
NPI:1306187877
Name:SMITH, JEANNE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:RADWANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5 LINDBERGH LN
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1207
Mailing Address - Country:US
Mailing Address - Phone:973-945-0406
Mailing Address - Fax:
Practice Address - Street 1:737 ROUTE 22 WEST
Practice Address - Street 2:ETHICON EMPLOYEE HEALTH CENTER
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-218-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00652000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist