Provider Demographics
NPI:1114483690
Name:SCHRAMM, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHRAMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1041
Mailing Address - Country:US
Mailing Address - Phone:315-462-3588
Mailing Address - Fax:315-906-0058
Practice Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1041
Practice Address - Country:US
Practice Address - Phone:315-462-3588
Practice Address - Fax:315-906-0058
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06109080Medicaid