Provider Demographics
NPI:1154414472
Name:SCHMOOKLER, SANFORD M (MS PT)
Entity type:Individual
Prefix:MR
First Name:SANFORD
Middle Name:M
Last Name:SCHMOOKLER
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15191
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-5191
Mailing Address - Country:US
Mailing Address - Phone:850-509-2400
Mailing Address - Fax:850-216-4036
Practice Address - Street 1:1837 BUFORD CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4465
Practice Address - Country:US
Practice Address - Phone:850-216-4033
Practice Address - Fax:850-216-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4548Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER