Provider Demographics
NPI:1891711008
Name:SMART CLINIC LIMITED PRACTICE
Entity Type:Organization
Organization Name:SMART CLINIC LIMITED PRACTICE
Other - Org Name:SMART CLINIC LIMITED PARTNERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAT
Authorized Official - Phone:262-754-3446
Mailing Address - Street 1:13825 W BURLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3058
Mailing Address - Country:US
Mailing Address - Phone:262-754-3450
Mailing Address - Fax:262-754-3451
Practice Address - Street 1:13825 W BURLEIGH RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-754-3450
Practice Address - Fax:262-754-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty