Provider Demographics
NPI:1225860984
Name:SCHRAEDER, JENNIFER ELAINE (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:SCHRAEDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 405 BOX 6179
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034-0162
Mailing Address - Country:US
Mailing Address - Phone:805-757-2481
Mailing Address - Fax:
Practice Address - Street 1:8741 FERN STREET
Practice Address - Street 2:ROOM 109B
Practice Address - City:BAUMHOLDER
Practice Address - State:RHINELAND-PALATINATE
Practice Address - Zip Code:55774
Practice Address - Country:DE
Practice Address - Phone:314-590-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA11300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant