MEDICARE: COURDELL RUTH SCHAETZLE PT,DPT,ATC

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	LPT-31491	AZ

General Provider Information

NPI Number	:	1417472390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURDELL RUTH SCHAETZLE PT,DPT,ATC

Provider Business Mailing Address
First Line	:	17233 N HOLMES BLVD STE 1650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2031
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:

Provider Business Practice Location Address
First Line	:	17233 N HOLMES BLVD STE 1650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2031
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	10/07/2020

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