Provider Demographics
NPI:1265090328
Name:SCHWARTZ, SAMUEL LOREN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LOREN
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 BIG SKY DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162-9779
Mailing Address - Country:US
Mailing Address - Phone:920-619-3509
Mailing Address - Fax:
Practice Address - Street 1:3475 OMRO RD STE 300
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7126
Practice Address - Country:US
Practice Address - Phone:920-230-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14596-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist