Provider Demographics
NPI:1497429633
Name:SCHIELTZ, DANIEL MARVIN (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARVIN
Last Name:SCHIELTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8332
Mailing Address - Country:US
Mailing Address - Phone:563-581-2813
Mailing Address - Fax:
Practice Address - Street 1:725 GROVE ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4756
Practice Address - Country:US
Practice Address - Phone:707-687-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108883225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant