Provider Demographics
NPI:1952384331
Name:MARY JO SCHMITZ
Entity Type:Organization
Organization Name:MARY JO SCHMITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-853-8055
Mailing Address - Street 1:3330 OLD GLENVIEW RD
Mailing Address - Street 2:STE 4
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2963
Mailing Address - Country:US
Mailing Address - Phone:847-853-8055
Mailing Address - Fax:847-853-8057
Practice Address - Street 1:3330 OLD GLENVIEW RD
Practice Address - Street 2:STE 4
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:847-853-8055
Practice Address - Fax:847-853-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605050OtherBCBS
349960Medicare ID - Type Unspecified