Provider Demographics
NPI:1306853551
Name:SCHEIDERER, JENNIFER LEA (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:SCHEIDERER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3530
Mailing Address - Country:US
Mailing Address - Phone:260-432-2012
Mailing Address - Fax:
Practice Address - Street 1:3030 LAKE AVE STE 24
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5428
Practice Address - Country:US
Practice Address - Phone:260-424-8830
Practice Address - Fax:260-424-8868
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006689A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist