Provider Demographics
NPI:1093290173
Name:SCHMIEDER, TANYA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:SCHMIEDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2020
Mailing Address - Country:US
Mailing Address - Phone:810-487-9733
Mailing Address - Fax:810-867-4938
Practice Address - Street 1:209 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2020
Practice Address - Country:US
Practice Address - Phone:810-487-9733
Practice Address - Fax:810-867-4938
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5502001008OtherSTATE LICENSE