Healthcare Provider Details

I. General information

NPI: 1659760619
Provider Name (Legal Business Name): MITCHELL OWEN SCHROEDER PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 WARNER AVE.
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

2020 FULLERTON AVE. APT. 23
COSTA MESA CA
92627
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-3800
  • Fax: 714-847-1413
Mailing address:
  • Phone: 303-728-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0013159
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: