Healthcare Provider Details

I. General information

NPI: 1053059006
Provider Name (Legal Business Name): BRIAN SCHAUDT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 JAY ST
FOSSIL OR
97830-8371
US

IV. Provider business mailing address

712 JAY ST
FOSSIL OR
97830-8371
US

V. Phone/Fax

Practice location:
  • Phone: 541-763-2725
  • Fax: 541-763-2850
Mailing address:
  • Phone: 541-763-2725
  • Fax: 541-763-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number64491
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: