MEDICARE: MARY JOANN SCHAFER 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	5501013102	MI

General Provider Information

NPI Number	:	1801914486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JOANN SCHAFER PT

Provider Business Mailing Address
First Line	:	4116 BURNHAM AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1914
Country	:	US
Telephone Number	:	419-478-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 W MAUMEE ST
Second Line	:	SUITE 3
City	:	ADRIAN
State	:	MI
Zip	:	49221-1899
Country	:	US
Telephone Number	:	517-265-6007
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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