Provider Demographics
NPI:1275838716
Name:WOLLSCHLAGER, JOAN (LMT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:WOLLSCHLAGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2896 WOODROW DR NE
Mailing Address - Street 2:
Mailing Address - City:SWISHER
Mailing Address - State:IA
Mailing Address - Zip Code:52338-9474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2896 WOODROW DR NE
Practice Address - Street 2:
Practice Address - City:SWISHER
Practice Address - State:IA
Practice Address - Zip Code:52338-9474
Practice Address - Country:US
Practice Address - Phone:319-841-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist