Healthcare Provider Details

I. General information

NPI: 1720376627
Provider Name (Legal Business Name): JESSICA LEA SCHROEDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 01/19/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 CORAL CT STE 1
CORALVILLE IA
52241-2809
US

IV. Provider business mailing address

8434 CORCORAN RD
WILLOW SPRINGS IL
60480-1666
US

V. Phone/Fax

Practice location:
  • Phone: 319-259-6224
  • Fax:
Mailing address:
  • Phone: 708-467-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23678
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: