Provider Demographics
NPI:1790929834
Name:SCHWARTZ, SUE A (PT)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:A
Other - Last Name:MASSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 COUNTY ROAD 526
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65035-2130
Mailing Address - Country:US
Mailing Address - Phone:573-455-2297
Mailing Address - Fax:573-636-3247
Practice Address - Street 1:62 COUNTY ROAD 526
Practice Address - Street 2:
Practice Address - City:FREEBURG
Practice Address - State:MO
Practice Address - Zip Code:65035-2130
Practice Address - Country:US
Practice Address - Phone:573-455-2297
Practice Address - Fax:573-636-3247
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist