Provider Demographics
NPI:1215525514
Name:SCHALDACH, EMILY (MT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SCHALDACH
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W WISCONSIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2493
Mailing Address - Country:US
Mailing Address - Phone:608-269-4511
Mailing Address - Fax:608-788-8103
Practice Address - Street 1:415 W WISCONSIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2493
Practice Address - Country:US
Practice Address - Phone:608-269-4511
Practice Address - Fax:608-788-8103
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15320-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist