Provider Demographics
NPI:1447456256
Name:THERESA A. SCHMIDT, MS,PT,PC
Entity type:Organization
Organization Name:THERESA A. SCHMIDT, MS,PT,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT,OCS,LMT
Authorized Official - Phone:631-226-2191
Mailing Address - Street 1:208 E ALHAMBRA AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6504
Mailing Address - Country:US
Mailing Address - Phone:631-226-2191
Mailing Address - Fax:631-226-2191
Practice Address - Street 1:208 E ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6504
Practice Address - Country:US
Practice Address - Phone:631-226-2191
Practice Address - Fax:631-226-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQBWQZ1Medicare UPIN