MEDICARE: CONOR SCHMIDT DPT

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	041485-1	NY
2	225100000X	Physical Therapist	PT03363	RI
3	225100000X	Physical Therapist	10808	CT

General Provider Information

NPI Number	:	1770941643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONOR SCHMIDT DPT

Provider Business Mailing Address
First Line	:	91 POINT JUDITH RD UNIT D7
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-3468
Country	:	US
Telephone Number	:	401-584-9098
Fax Number	:	401-515-7641

Provider Business Practice Location Address
First Line	:	91 POINT JUDITH RD UNIT D7
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-3468
Country	:	US
Telephone Number	:	401-584-9098
Fax Number	:	401-515-7641

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

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	01/20/2022

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