MEDICARE: MR. ANDREW M SCHRAG BSC PT

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	225100000X	Physical Therapist	PT013084L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50073174	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1770560633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW M SCHRAG BSC PT

Provider Business Mailing Address
First Line	:	15050 KUTZTOWN RD
Second Line	:	P.O. BOX 210
City	:	KUTZTOWN
State	:	PA
Zip	:	19530-9275
Country	:	US
Telephone Number	:	610-683-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 TUNNEL RD
Second Line	:	STE. 202
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-3875
Country	:	US
Telephone Number	:	570-622-0182
Fax Number	:	570-622-3192

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	01/30/2008

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