Provider Demographics
NPI:1104539147
Name:SCHMIED, MCKENNA ANN HOMNER (DPT)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:ANN HOMNER
Last Name:SCHMIED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:ANN
Other - Last Name:HOMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30972 W CHEERY LYNN RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-6785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30972 W CHEERY LYNN RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-6785
Practice Address - Country:US
Practice Address - Phone:720-975-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist