=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396250825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL SCHMIDT LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1804 OWEN CT STE 102
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-4235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-225-5431
-----------------------------------------------------
Fax | 817-453-9780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 KENSINGTON LN
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-2820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-225-5431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT105168
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------