Healthcare Provider Details

I. General information

NPI: 1043457864
Provider Name (Legal Business Name): NATHAN RAY SCHMIDT LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N CUMBERLAND AVE SUITE 19
NORRIDGE IL
60706-2905
US

IV. Provider business mailing address

460 VASSAR LN # 2C
DES PLAINES IL
60016-2037
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070012431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: