Healthcare Provider Details

I. General information

NPI: 1073398012
Provider Name (Legal Business Name): AUSTIN THEODORE SCHMITT PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 LOMBARDI AVE
GREEN BAY WI
54304-3927
US

IV. Provider business mailing address

2100 HOLMGREN WAY UNIT 111
GREEN BAY WI
54304-4649
US

V. Phone/Fax

Practice location:
  • Phone: 920-569-7500
  • Fax:
Mailing address:
  • Phone: 320-226-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number17242-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3261-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: