Provider Demographics
NPI:1447373360
Name:SCHOMBURG, FRED L (PT)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:L
Last Name:SCHOMBURG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 ROUTE 989
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2751
Mailing Address - Country:US
Mailing Address - Phone:724-774-1167
Mailing Address - Fax:724-774-7256
Practice Address - Street 1:1197 ROUTE 989
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2751
Practice Address - Country:US
Practice Address - Phone:724-774-1167
Practice Address - Fax:724-774-7256
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000273E172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath