Healthcare Provider Details

I. General information

NPI: 1225860984
Provider Name (Legal Business Name): JENNIFER ELAINE SCHRAEDER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 FERN STREET ROOM 109B
BAUMHOLDER RHINELAND-PALATINATE
55774
DE

IV. Provider business mailing address

CMR 405 BOX 6179
APO AE
09034-0162
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1003
  • Fax:
Mailing address:
  • Phone: 805-757-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA11300
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: