1285940122 NPI number — MISS STACEY LYNN SCHORR DPT

Table of content: MISS STACEY LYNN SCHORR DPT (NPI 1285940122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285940122 NPI number — MISS STACEY LYNN SCHORR DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHORR
Provider First Name:
STACEY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POKRYWKA
Provider Other First Name:
STACEY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285940122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-2223
Provider Business Mailing Address Fax Number:
630-759-3251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021A EMMORTON RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21015-8962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-515-0006
Provider Business Practice Location Address Fax Number:
410-515-0027
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  23364 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01304981 . This is a "MCRR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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