Provider Demographics
NPI:1255418067
Name:SCHWALL, MARK F (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:SCHWALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2912
Mailing Address - Country:US
Mailing Address - Phone:732-849-0080
Mailing Address - Fax:732-849-1088
Practice Address - Street 1:640 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2100
Practice Address - Country:US
Practice Address - Phone:609-756-5800
Practice Address - Fax:888-974-0986
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00629000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077842Medicare ID - Type Unspecified