Provider Demographics
NPI:1255445680
Name:SMEJKAL, LEAH K (PT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:SMEJKAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:K
Other - Last Name:ZIMDARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2005
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:114 E. GREENTREE ROAD
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929
Practice Address - Country:US
Practice Address - Phone:715-823-3336
Practice Address - Fax:715-823-3936
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6394-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI650023249OtherRAILROAD MEDICARE
WI40364000Medicaid
WI650023249OtherRAILROAD MEDICARE
WI000886015Medicare ID - Type Unspecified