Provider Demographics
NPI:1255508255
Name:SCHUMANN, LORI A (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:SCHUMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:NASHOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:2817 NEW PINERY ROAD
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-0387
Mailing Address - Country:US
Mailing Address - Phone:608-745-5063
Mailing Address - Fax:608-745-6250
Practice Address - Street 1:2817 NEW PINERY ROAD
Practice Address - Street 2:DIVINE SAVIOR HEALTHCARE
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-0387
Practice Address - Country:US
Practice Address - Phone:608-745-5063
Practice Address - Fax:608-745-6250
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3177-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40111800Medicaid