Provider Demographics
NPI:1912174566
Name:SCHMIDT, SUZANNE M (PT)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:M
Last Name:SCHMIDT
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 1:3200 S 20TH ST
Mailing Address - Street 2:TSF
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-389-3274
Mailing Address - Fax:414-389-3225
Practice Address - Street 1:3200 S 20TH ST
Practice Address - Street 2:TSF
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-389-3274
Practice Address - Fax:414-389-3225
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1176024225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40142600Medicaid