Provider Demographics
NPI:1962675751
Name:SCHUBERT, ROGELITA AMURAO (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROGELITA
Middle Name:AMURAO
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:RIB LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54470-9322
Mailing Address - Country:US
Mailing Address - Phone:715-427-5297
Mailing Address - Fax:
Practice Address - Street 1:650 PEARL ST
Practice Address - Street 2:
Practice Address - City:RIB LAKE
Practice Address - State:WI
Practice Address - Zip Code:54470-9322
Practice Address - Country:US
Practice Address - Phone:715-427-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9921-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40382200Medicaid