Provider Demographics
NPI:1891401212
Name:VON SCHILLING WORTH, ELDERIZE (BA, CT, CTR)
Entity Type:Individual
Prefix:
First Name:ELDERIZE
Middle Name:
Last Name:VON SCHILLING WORTH
Suffix:
Gender:F
Credentials:BA, CT, CTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 S GREEN BAY RD STE C226
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4957
Mailing Address - Country:US
Mailing Address - Phone:414-285-1331
Mailing Address - Fax:
Practice Address - Street 1:2310 S GREEN BAY RD STE C266
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4957
Practice Address - Country:US
Practice Address - Phone:414-285-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI92-1960720OtherWORKERS COMPENSATION AND PERSONAL INJURY