Healthcare Provider Details

I. General information

NPI: 1215709423
Provider Name (Legal Business Name): TAYLOR SCHUBERT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 WILLIAM ST
CAPE GIRARDEAU MO
63703-6575
US

IV. Provider business mailing address

3561 BRUNSWICK CT
CAPE GIRARDEAU MO
63701-9783
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-5989
  • Fax:
Mailing address:
  • Phone: 573-225-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43169324
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: