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General NPI Number Information
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NPI Number | 1801456553
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Entity Type | Individual
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Provider Name | ELIZABETH SCHAEFER ATC
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Gender | Female
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Dates
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Enumeration Date | 06/15/2019
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Last Update Date | 06/15/2019
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Provider Practice Location Address
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Address Line | 7601 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4133
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Country | US
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Telephone | 260-436-6326
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Fax |
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Provider Business Mailing Address
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Address Line | 14024 HILDEBRAND RD
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City | FORT WAYNE
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State | IN
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Zip | 46818-9434
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Country | US
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Telephone | 260-515-2388
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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 | 2000036637
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License Number State | IN
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