Provider Demographics
NPI:1710930961
Name:SCHMIDT, PAUL NORMAN (MPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:NORMAN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN
Mailing Address - Street 2:STE 600C
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:25250 75TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-8705
Practice Address - Country:US
Practice Address - Phone:262-843-4200
Practice Address - Fax:262-843-4578
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014234225100000X
WI6198024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40338900Medicaid
WI0604410001Medicare NSC
ILK15735Medicare ID - Type Unspecified
WI001885940Medicare ID - Type Unspecified
ILK15734Medicare ID - Type Unspecified