Provider Demographics
NPI:1033726245
Name:SMITH, BRENNA (DPT)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 CORNERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1503
Mailing Address - Country:US
Mailing Address - Phone:262-928-9725
Mailing Address - Fax:262-928-9721
Practice Address - Street 1:808 CORNERSTONE CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-1503
Practice Address - Country:US
Practice Address - Phone:262-928-9725
Practice Address - Fax:262-928-9721
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15223-54225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist