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General NPI Number Information
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NPI Number | 1043457864
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Entity Type | Individual
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Provider Name | NATHAN RAY SCHMIDT LPT
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Gender | Male
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 4701 N CUMBERLAND AVE SUITE 19
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City | NORRIDGE
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State | IL
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Zip | 60706-2905
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Country | US
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Telephone | 708-456-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 460 VASSAR LN # 2C
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City | DES PLAINES
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State | IL
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Zip | 60016-2037
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070012431
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License Number State | IL
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