Healthcare Provider Details

I. General information

NPI: 1790721439
Provider Name (Legal Business Name): JONATHAN J SCHAEFER LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E. MEXICO AVE., SUITE 210 CENTERPOINT 1
DENVER CO
80210-3940
US

IV. Provider business mailing address

3900 E. MEXICO AVE., SUITE 210 CENTERPOINT 1
DENVER CO
80210-3940
US

V. Phone/Fax

Practice location:
  • Phone: 303-691-3733
  • Fax: 303-691-1142
Mailing address:
  • Phone: 303-691-3733
  • Fax: 303-691-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number070009821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: