Provider Demographics
NPI:1083838049
Name:SCHWAB, STEVEN M (MA PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:MA PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 E 82 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5894
Mailing Address - Country:US
Mailing Address - Phone:208-745-8580
Mailing Address - Fax:208-745-8580
Practice Address - Street 1:4102 E 82 N
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5894
Practice Address - Country:US
Practice Address - Phone:208-745-8580
Practice Address - Fax:208-745-8580
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT-6865OtherBX PROVIDER ID
ID002591700Medicaid
ID806469200Medicaid
ID1654675Medicare ID - Type Unspecified
ID1650444Medicare PIN