Healthcare Provider Details

I. General information

NPI: 1902615271
Provider Name (Legal Business Name): MICHAEL SCHOMER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 E LOUISE DR STE 410
MERIDIAN ID
83642-9360
US

IV. Provider business mailing address

2705 W CASSIA ST
BOISE ID
83705-1755
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-5800
  • Fax:
Mailing address:
  • Phone: 402-980-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3261875
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: