Provider Demographics
NPI:1306015706
Name:SCHATZ, JOHANNA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:L
Last Name:SCHATZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1200 AVIATION BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4064
Practice Address - Country:US
Practice Address - Phone:310-374-6363
Practice Address - Fax:310-374-6767
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26326OtherPT LICENSE
CAPT0263260OtherBLUE SHIELD
CADG671AMedicare PIN