Provider Demographics
NPI:1871520684
Name:SCHMIDT, CYNTHIA M (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:STITES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0062
Mailing Address - Country:US
Mailing Address - Phone:970-244-7050
Mailing Address - Fax:970-255-1809
Practice Address - Street 1:1100 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8219
Practice Address - Country:US
Practice Address - Phone:970-244-6005
Practice Address - Fax:970-244-6159
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56789351Medicaid
COC806187Medicare PIN