=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083780472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNIE SCHEPERS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N ROLAND ST
-----------------------------------------------------
City | MC BAIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49657-9683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-884-4277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 384
-----------------------------------------------------
City | CADILLAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49601-0384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-775-6076
-----------------------------------------------------
Fax | 231-775-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501003169
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------