Healthcare Provider Details

I. General information

NPI: 1922507888
Provider Name (Legal Business Name): STEPHANIE CHRISTINE SCHWARTZ ATC, LAT, MS, ITAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 WILLIAMS PKWY SW
CEDAR RAPIDS IA
52404-1427
US

IV. Provider business mailing address

4915 MONTCLAIR DR NW
CEDAR RAPIDS IA
52405-2829
US

V. Phone/Fax

Practice location:
  • Phone: 319-366-3500
  • Fax:
Mailing address:
  • Phone: 815-210-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number087633
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: