Provider Demographics
NPI:1467648022
Name:SCHWARTZ, COLEEN ANN (PT)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:ANN
Last Name:SCHWARTZ
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 1:1681 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1381
Mailing Address - Country:US
Mailing Address - Phone:801-471-9522
Mailing Address - Fax:
Practice Address - Street 1:1681 HICKORY LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1381
Practice Address - Country:US
Practice Address - Phone:801-471-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120880-2401251E00000X
120880-2401313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility