Healthcare Provider Details

I. General information

NPI: 1679585848
Provider Name (Legal Business Name): CYGNET SCHROEDER DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S J ST
FORT SMITH AR
72901-5158
US

IV. Provider business mailing address

PO BOX 3363
FORT SMITH AR
72913-3363
US

V. Phone/Fax

Practice location:
  • Phone: 479-478-8555
  • Fax: 479-478-8568
Mailing address:
  • Phone: 479-478-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberR4158
License Number StateAR

VIII. Authorized Official

Name: CYGNET ANN SCHROEDER
Title or Position: PRESIDENT
Credential: DO
Phone: 479-478-8555