Healthcare Provider Details

I. General information

NPI: 1801375803
Provider Name (Legal Business Name): EMANUELLY MARIA SCHUBAUER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N CENTRAL AVE
KISSIMMEE FL
34741-4407
US

IV. Provider business mailing address

7829 SUMMERLAKE GROVES ST
WINTER GARDEN FL
34787-3159
US

V. Phone/Fax

Practice location:
  • Phone: 407-870-5959
  • Fax:
Mailing address:
  • Phone: 186-539-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: