Healthcare Provider Details

I. General information

NPI: 1336193382
Provider Name (Legal Business Name): JOSEPH SCHMERSAHL MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E BOONESLICK RD SUITE 3
WARRENTON MO
63383-2127
US

IV. Provider business mailing address

607 DEWEY AVE NW STE 300
GRAND RAPIDS MI
49504-2548
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-6350
  • Fax: 636-456-6084
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006005291
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: