Provider Demographics
NPI:1871591628
Name:SCHIEDEL, JENNIFER ELLEN (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:SCHIEDEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53606 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8046
Mailing Address - Country:US
Mailing Address - Phone:269-657-2540
Mailing Address - Fax:
Practice Address - Street 1:5717 OAKLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1116
Practice Address - Country:US
Practice Address - Phone:269-978-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist