Healthcare Provider Details

I. General information

NPI: 1679540728
Provider Name (Legal Business Name): DOUGLAS GERARD SCHAEFER L.P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 FOREST HILL RD
GRAND LEDGE MI
48837-9253
US

IV. Provider business mailing address

13685 FOREST HILL RD
GRAND LEDGE MI
48837-9253
US

V. Phone/Fax

Practice location:
  • Phone: 517-626-7112
  • Fax:
Mailing address:
  • Phone: 517-626-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06001753A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: