Healthcare Provider Details

I. General information

NPI: 1649320599
Provider Name (Legal Business Name): MARY R SCHMIDT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 STATE RT 153
SECAUCUS NJ
07094-3445
US

IV. Provider business mailing address

188 RIDGEWOOD AVE
STATEN ISLAND NY
10312-2435
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-0010
  • Fax:
Mailing address:
  • Phone: 718-948-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01215800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: