Provider Demographics
NPI:1124259429
Name:SCHRODER, MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCHRODER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11681 BROOKS SCHOOL RD
Practice Address - Street 2:UNIT 1
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9743
Practice Address - Country:US
Practice Address - Phone:317-813-0148
Practice Address - Fax:317-913-1482
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010036A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200958090Medicaid
INP00809400OtherRAILROAD MEDICARE PIN
IN727130GMedicare PIN
IN555850046Medicare PIN