Provider Demographics
NPI:1902376866
Name:SCHWERTNER, DIEDRA (LAT, ATC, MED)
Entity Type:Individual
Prefix:
First Name:DIEDRA
Middle Name:
Last Name:SCHWERTNER
Suffix:
Gender:F
Credentials:LAT, ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 SAN AUGUSTINE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5094
Mailing Address - Country:US
Mailing Address - Phone:254-718-9779
Mailing Address - Fax:
Practice Address - Street 1:1300 FM 1103
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3758
Practice Address - Country:US
Practice Address - Phone:210-619-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer