Provider Demographics
NPI:1942813035
Name:SCHWARTZ, DUSTIN SHANE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:SHANE
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 ELMO WAY
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2385
Mailing Address - Country:US
Mailing Address - Phone:405-863-2147
Mailing Address - Fax:
Practice Address - Street 1:4554 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4452
Practice Address - Country:US
Practice Address - Phone:405-366-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty