Provider Demographics
NPI:1154587061
Name:SMART, ANNA CAMILLE (LMT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CAMILLE
Last Name:SMART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:W9833 SKANDINAVA LN
Mailing Address - Street 2:
Mailing Address - City:ELROY
Mailing Address - State:WI
Mailing Address - Zip Code:53929-9635
Mailing Address - Country:US
Mailing Address - Phone:608-462-4010
Mailing Address - Fax:608-462-4010
Practice Address - Street 1:W9833 SKANDINAVA LN
Practice Address - Street 2:
Practice Address - City:ELROY
Practice Address - State:WI
Practice Address - Zip Code:53929-9635
Practice Address - Country:US
Practice Address - Phone:608-462-4010
Practice Address - Fax:608-462-4010
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI202879691175L00000X
WI1724-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI202879691OtherTAX ID