Provider Demographics
NPI:1548301815
Name:SCHROEDER, MARK ANDREW (MS PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 TERRA GRANADA DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-4078
Mailing Address - Country:US
Mailing Address - Phone:831-747-0455
Mailing Address - Fax:
Practice Address - Street 1:1388 PLUMMER ST PRESIDIO OF MONTEREY
Practice Address - Street 2:CPAC, BLDG 277
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-5006
Practice Address - Country:US
Practice Address - Phone:831-242-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101322Medicare PIN
HI101238Medicare PIN
HIVAD000Medicare UPIN