Provider Demographics
NPI:1396250825
Name:SCHMIDT, CAROL (LMT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2820
Mailing Address - Country:US
Mailing Address - Phone:817-225-5431
Mailing Address - Fax:
Practice Address - Street 1:1804 OWEN CT STE 102
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4235
Practice Address - Country:US
Practice Address - Phone:817-225-5431
Practice Address - Fax:817-453-9780
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT105168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT105168OtherSTATE ISSUED LICENSE