Provider Demographics
NPI:1083929079
Name:SCHMIDT, MARY L (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STONE RIDGE CIRCLE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3547
Mailing Address - Country:US
Mailing Address - Phone:314-966-8655
Mailing Address - Fax:
Practice Address - Street 1:201 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4305
Practice Address - Country:US
Practice Address - Phone:314-984-9220
Practice Address - Fax:314-984-9225
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist