Provider Demographics
NPI:1063844124
Name:SCHUMACHER, KYLE S (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:S
Last Name:SCHUMACHER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E ENTERPRISE AVE # 113
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:920-991-2561
Mailing Address - Fax:920-560-1197
Practice Address - Street 1:5000 W CHAMPION DR
Practice Address - Street 2:
Practice Address - City:GRAND CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54913-5000
Practice Address - Country:US
Practice Address - Phone:920-560-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019941225100000X
WI12351-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist