Healthcare Provider Details

I. General information

NPI: 1750831582
Provider Name (Legal Business Name): ADAM SCHAETZLE CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S.W. ARCHER ROAD NORTH FLORIDA / SOUTH GEORGIA MALCOLM RANDAL VAMC
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

2924 NW 76TH TER
GAINESVILLE FL
32606-6266
US

V. Phone/Fax

Practice location:
  • Phone: 352-548-6000
  • Fax:
Mailing address:
  • Phone: 352-231-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number65202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: