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General NPI Number Information
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NPI Number | 1659331379
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Entity Type | Individual
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Provider Name | PAUL D SCHMIDT ATC
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Gender | Male
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1402 SOUTH FIRST STREET MEMORIAL STADIUM
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City | CHAMPAIGN
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State | IL
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Zip | 61820
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Country | US
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Telephone | 217-265-8060
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Fax | 217-333-6460
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Provider Business Mailing Address
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Address Line | 705 KREBS DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1102
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Country | US
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Telephone | 248-302-0514
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096.002426
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License Number State | IL
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