MEDICARE: LISA SCHAEFER P.T.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2749	AR
2	225100000X	Physical Therapist	PT5394	MS
3	225100000X	Physical Therapist	PT2749	AR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	662725	OTHER	AR	HEALTHLINK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	445934001	OTHER	AR	PALMETTO GI DME
4	5X979	OTHER	AR	BLUE CROSS BLUE SHIELD
5	71085780150	OTHER	AR	QUALCHOICE

NPI Number	:	1609824390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SCHAEFER P.T.

Provider Business Mailing Address
First Line	:	PO DRAWER 2109
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811
Country	:	US
Telephone Number	:	479-967-2322
Fax Number	:	479-967-2876

Provider Business Practice Location Address
First Line	:	272 SCHOOL AVE
Second Line	:
City	:	WEST FORK
State	:	AR
Zip	:	72774-3124
Country	:	US
Telephone Number	:	479-839-3349
Fax Number	:	479-839-3752

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/16/2023

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308