Provider Demographics
NPI:1669094330
Name:SMETANA, JANE EDNA (PTA)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:EDNA
Last Name:SMETANA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2999 N MAYFAIR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4306
Mailing Address - Country:US
Mailing Address - Phone:414-479-3737
Mailing Address - Fax:414-479-3733
Practice Address - Street 1:2999 N MAYFAIR RD STE 300
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4306
Practice Address - Country:US
Practice Address - Phone:414-479-3737
Practice Address - Fax:414-479-3733
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI584-192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine