MEDICARE: KELSEY SCHAUB DPT, PT

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	PT015498	OH
2	225100000X	Physical Therapist	43487	CA
3	225100000X	Physical Therapist	4646	NM
4	225100000X	Physical Therapist	11992	AZ
5	225100000X	Physical Therapist	CP012030T	WA
6	225100000X	Physical Therapist	63694	OR

General Provider Information

NPI Number	:	1427593813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY SCHAUB DPT, PT

Provider Business Mailing Address
First Line	:	1720 SW 4TH AVE APT 413
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5533
Country	:	US
Telephone Number	:	971-420-3301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 SW 4TH AVE APT 413
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5533
Country	:	US
Telephone Number	:	971-420-3301
Fax Number	:

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

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	07/13/2022

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