Provider Demographics
NPI:1992174791
Name:SCHOENFELDER, GARETT (LAT, ATC)
Entity type:Individual
Prefix:
First Name:GARETT
Middle Name:
Last Name:SCHOENFELDER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 S JUNYA ST
Mailing Address - Street 2:APT 25101
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3531
Mailing Address - Country:US
Mailing Address - Phone:616-824-0840
Mailing Address - Fax:
Practice Address - Street 1:563 S JUNYA ST
Practice Address - Street 2:APT 25101
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3531
Practice Address - Country:US
Practice Address - Phone:616-824-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002406A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer