Provider Demographics
NPI:1740808674
Name:SCHILDWACHTER, JOSEPH MICHAEL (ATC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:SCHILDWACHTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ALBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1529
Mailing Address - Country:US
Mailing Address - Phone:443-981-0057
Mailing Address - Fax:
Practice Address - Street 1:1864 STADIUM RD
Practice Address - Street 2:100FLGYM
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-8205
Practice Address - Country:US
Practice Address - Phone:352-392-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program