Healthcare Provider Details

I. General information

NPI: 1497429633
Provider Name (Legal Business Name): DANIEL MARVIN SCHIELTZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GROVE ST
HEALDSBURG CA
95448-4756
US

IV. Provider business mailing address

1076 ROOSEVELT ST
DUBUQUE IA
52001-8332
US

V. Phone/Fax

Practice location:
  • Phone: 707-687-9633
  • Fax:
Mailing address:
  • Phone: 563-581-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number108883
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: