Provider Demographics
NPI:1417243585
Name:SCHOENHOLZ, KATIE JO (P,T, ATC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:SCHOENHOLZ
Suffix:
Gender:F
Credentials:P,T, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1533
Mailing Address - Country:US
Mailing Address - Phone:504-554-1696
Mailing Address - Fax:
Practice Address - Street 1:8137 W ROSEBURY DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2402
Practice Address - Country:US
Practice Address - Phone:504-554-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist