Provider Demographics
NPI:1699740803
Name:SCHOENFELDER, MARK THOMAS (ATC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:SCHOENFELDER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1562
Mailing Address - Country:US
Mailing Address - Phone:402-316-8266
Mailing Address - Fax:
Practice Address - Street 1:1111 MAIN ST
Practice Address - Street 2:WILDCAT SPORTS MEDICINE CENTER
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1181
Practice Address - Country:US
Practice Address - Phone:402-375-7582
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer