Basic Information
| Provider Information | |||||||||
| NPI: | 1710930961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | NORMAN | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 OAKMONT LN | ||||||||
| Address2: | STE 600C | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305751980 | ||||||||
| FaxNumber: | 6309285080 | ||||||||
| Practice Location | |||||||||
| Address1: | 25250 75TH ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531688705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2628434200 | ||||||||
| FaxNumber: | 2628434578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070014234 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 6198024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40338900 | 05 | WI | MEDICAID |