=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962283135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEAH SCHMITT PHYSICAL THERAPY LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2023
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 W HUBBARD ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60642-6337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-278-7771
-----------------------------------------------------
Fax | 312-277-3275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1279 PLANTATION DR
-----------------------------------------------------
City | BETHEL PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15102-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-278-7771
-----------------------------------------------------
Fax | 312-277-3275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LEAH SCHMITT
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 312-278-7771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------