Provider Demographics
NPI:1154626653
Name:SCHMITZ, MARY JO (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:3330 OLD GLENVIEW RD.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091
Mailing Address - Country:US
Mailing Address - Phone:847-853-8055
Mailing Address - Fax:847-853-8057
Practice Address - Street 1:3330 OLD GLENVIEW RD.
Practice Address - Street 2:SUITE 4
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091
Practice Address - Country:US
Practice Address - Phone:847-853-8055
Practice Address - Fax:847-853-8057
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070-002868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL349960Medicare PIN