Healthcare Provider Details

I. General information

NPI: 1740416965
Provider Name (Legal Business Name): BENJAMIN L. SCHAUB PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 WATERBURY FALLS DR
O FALLON MO
63368-2202
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 636-336-0300
  • Fax: 636-336-0297
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2009022188
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2009012806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: