Provider Demographics
NPI:1053823146
Name:SCHWER, THERESA JOY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JOY
Last Name:SCHWER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:JOY
Other - Last Name:MILISAUSKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1615 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-1520
Mailing Address - Country:US
Mailing Address - Phone:262-551-0544
Mailing Address - Fax:
Practice Address - Street 1:3506 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1654
Practice Address - Country:US
Practice Address - Phone:262-818-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1630-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant