Provider Demographics
NPI:1528208576
Name:SCHWARTZ, LORRAIN MARGARET (RPT)
Entity Type:Individual
Prefix:
First Name:LORRAIN
Middle Name:MARGARET
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 GOLD STAR HWY
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1214
Mailing Address - Country:US
Mailing Address - Phone:860-961-6728
Mailing Address - Fax:
Practice Address - Street 1:2906 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1214
Practice Address - Country:US
Practice Address - Phone:860-961-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist