MEDICARE: DOUGLAS SCHAFER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA18685	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA18685	OTHER	FL	LICENSE #

General Provider Information

NPI Number	:	1174633887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS SCHAFER

Provider Business Mailing Address
First Line	:	4760 OLIVE BRANCH RD
Second Line	:	APT 1604
City	:	ORLANDO
State	:	FL
Zip	:	32811-7398
Country	:	US
Telephone Number	:	407-420-1061
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 S ORANGE AVE
Second Line	:	STE 101
City	:	ORLANDO
State	:	FL
Zip	:	32806-2154
Country	:	US
Telephone Number	:	407-522-4525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/01/2008

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Directions to “ DOUGLAS SCHAFER ” Practice Location

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