Provider Demographics
NPI:1770863102
Name:SCHWARTZ, IVY BETH (LMT)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:BETH
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 SW BRADBURY ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6057
Mailing Address - Country:US
Mailing Address - Phone:954-309-3114
Mailing Address - Fax:
Practice Address - Street 1:4413 SW BRADBURY STREET
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:954-309-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist