Individual
AMY BETH SMEDEMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
632 S JACKSON ST, GREEN BAY, WI 54301-3512
(920) 217-4959
Mailing address
632 S JACKSON ST, GREEN BAY, WI 54301-3512
(920) 217-4959
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1961-19
WI
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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