Healthcare Provider Details

I. General information

NPI: 1982178745
Provider Name (Legal Business Name): JOHN VINCENT SCHUELLER ATS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 E HUMBOLDT ST
PIERRE SD
57501-3633
US

IV. Provider business mailing address

1718 E HUMBOLDT ST
PIERRE SD
57501-3633
US

V. Phone/Fax

Practice location:
  • Phone: 605-295-1231
  • Fax:
Mailing address:
  • Phone: 605-295-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2644
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: