Provider Demographics
NPI:1528126687
Name:SCHROEDER, ALISHA ELIZABETH (DPT)
Entity type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:ELIZABETH
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:ALISHA
Other - Middle Name:ELIZABETH
Other - Last Name:REES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:22116 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63452
Mailing Address - Country:US
Mailing Address - Phone:217-430-1631
Mailing Address - Fax:573-288-1223
Practice Address - Street 1:22116 180TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452
Practice Address - Country:US
Practice Address - Phone:217-430-4631
Practice Address - Fax:573-288-1223
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000804225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO806271244504U8Medicaid