MEDICARE: ELDERIZE VON SCHILLING WORTH BA, CT, CTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92-1960720	OTHER	WI	WORKERS COMPENSATION AND PERSONAL INJURY

General Provider Information

NPI Number	:	1891401212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDERIZE VON SCHILLING WORTH BA, CT, CTR

Provider Business Mailing Address
First Line	:	2310 S GREEN BAY RD STE C226
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-4957
Country	:	US
Telephone Number	:	414-285-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 S GREEN BAY RD STE C266
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-4957
Country	:	US
Telephone Number	:	414-285-1331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	05/31/2023

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