Provider Demographics
NPI:1053469429
Name:SCHMIDT, HERALD E (PT)
Entity Type:Individual
Prefix:
First Name:HERALD
Middle Name:E
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0363
Mailing Address - Country:US
Mailing Address - Phone:208-265-0534
Mailing Address - Fax:208-265-0875
Practice Address - Street 1:1221 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1745
Practice Address - Country:US
Practice Address - Phone:208-265-0534
Practice Address - Fax:208-265-0875
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1575225100000X
COPTL3518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT7382OtherBLUE CROSS PROVIDER NUMBE
ID806611601Medicaid
ID10142849OtherBLUE SHIELD PROVIDER #
ID806611601Medicaid