Healthcare Provider Details

I. General information

NPI: 1003482886
Provider Name (Legal Business Name): BRIAN SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MORGAN DR
CARLISLE PA
17015-7935
US

IV. Provider business mailing address

37 MORGAN DR
CARLISLE PA
17015-7935
US

V. Phone/Fax

Practice location:
  • Phone: 717-254-3409
  • Fax:
Mailing address:
  • Phone: 717-254-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier20000041531
Identifier TypeOTHER
Identifier State
Identifier IssuerBOC CERTIFICATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: