Provider Demographics
NPI:1306254339
Name:SCHROEDER, JACOB AUSTIN (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:AUSTIN
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6748 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9162
Mailing Address - Country:US
Mailing Address - Phone:812-345-1913
Mailing Address - Fax:
Practice Address - Street 1:1200 N GIRLS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3499
Practice Address - Country:US
Practice Address - Phone:317-988-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002398A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer