Provider Demographics
NPI:1598249013
Name:SCHROEDER, MARY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:SCHROEDER
Suffix:
Gender:F
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:W4978 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:BONDUEL
Mailing Address - State:WI
Mailing Address - Zip Code:54107-8805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-8407
Practice Address - Country:US
Practice Address - Phone:715-823-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2373-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant