Healthcare Provider Details

I. General information

NPI: 1528126687
Provider Name (Legal Business Name): ALISHA ELIZABETH SCHROEDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISHA ELIZABETH REES MPT

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22116 180TH AVE
LEWISTOWN MO
63452
US

IV. Provider business mailing address

22116 180TH AVE
LEWISTOWN MO
63452
US

V. Phone/Fax

Practice location:
  • Phone: 217-430-4631
  • Fax: 573-288-1223
Mailing address:
  • Phone: 217-430-1631
  • Fax: 573-288-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006000804
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: