MEDICARE: MACKENZIE LYNN SCHROEDER 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	2021006189	MO

General Provider Information

NPI Number	:	1891253704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE LYNN SCHROEDER PT

Provider Business Mailing Address
First Line	:	1982 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1609
Country	:	US
Telephone Number	:	636-949-3926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1982 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1609
Country	:	US
Telephone Number	:	636-949-3926
Fax Number	:

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

Provider Enumeration Date	:	03/10/2019
Last Update Date	:	08/19/2022

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