MEDICARE: KYLE S SCHUMACHER DPT

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	225100000X	Physical Therapist	070-019941	IL
2	225100000X	Physical Therapist	12351-24	WI

General Provider Information

NPI Number	:	1063844124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE S SCHUMACHER DPT

Provider Business Mailing Address
First Line	:	2105 E ENTERPRISE AVE # 113
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7862
Country	:	US
Telephone Number	:	920-991-2561
Fax Number	:	920-560-1197

Provider Business Practice Location Address
First Line	:	5000 W CHAMPION DR
Second Line	:
City	:	GRAND CHUTE
State	:	WI
Zip	:	54913-5000
Country	:	US
Telephone Number	:	920-560-1123
Fax Number	:

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	09/09/2021

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