Healthcare Provider Details

I. General information

NPI: 1962000612
Provider Name (Legal Business Name): KEITH SCHUCHARDT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 E RAY RD STE 104
GILBERT AZ
85296-4429
US

IV. Provider business mailing address

14287 N 87TH ST STE 220
SCOTTSDALE AZ
85260-3698
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-5542
  • Fax:
Mailing address:
  • Phone: 480-937-1000
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT31351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: