Location of Piest'any

Most of the town is located on the right bank of the river. South of the town is the Sĺňava water reservoir created by a dam on the Váh river. The artificial canal Biskupický kanál and the main river branch join in the town. Another short branch of the river (Obtokové rameno) creates the Spa Island.

The hills of Považský Inovec are mostly covered with deciduous forests. These consist of oak and hornbeam in the lower elevations, and beech in the higher elevations. The Váh valley is used for agriculture. The main products are cereals, sugar beet, animal feed, and pork.

Piešťany is located 75 km north-east of Bratislava, the capital of Slovakia, and 30 km north-east of the local regional seat Trnava. Upstream from Piešťany on the Váh river are the towns Nové Mesto nad Váhom (19 km north of Piešťany) and Trenčín (40 km north-east); 17 km downstream is Hlohovec.

Piešťany is located on the route of the D1 motorway from Bratislava to Žilina with connections to Vienna and Brno. The main railway route from Bratislava to Žilina and Košice also goes through the town. The town has an airport, mostly used for international charter flights for spa clients (10,000 passengers in 2007). The municipality operates a local public transport system with 11 bus routes (as of 2008)