Provider Demographics
NPI:1790771905
Name:SCHLACT, NORMAN H (MPT)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:H
Last Name:SCHLACT
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 1:3306 S WEST SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7644
Mailing Address - Country:US
Mailing Address - Phone:813-605-5646
Mailing Address - Fax:813-605-5647
Practice Address - Street 1:3306 S WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7644
Practice Address - Country:US
Practice Address - Phone:813-605-5646
Practice Address - Fax:813-605-5647
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892194600Medicaid
FLY9846XMedicare PIN