Healthcare Provider Details

I. General information

NPI: 1588622005
Provider Name (Legal Business Name): ANGELA DENISE SCHROEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10827 STATE ROUTE 12
COLUMBUS GROVE OH
45830-8202
US

IV. Provider business mailing address

10827 STATE ROUTE 12
COLUMBUS GROVE OH
45830-8202
US

V. Phone/Fax

Practice location:
  • Phone: 419-659-5643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: