Provider Demographics
NPI:1093392318
Name:SCHRODER, MITCHELL JOHN
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JOHN
Last Name:SCHRODER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 MAYFLOWER PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7908
Mailing Address - Country:US
Mailing Address - Phone:317-508-0839
Mailing Address - Fax:317-733-2829
Practice Address - Street 1:7031 MAYFLOWER PARK DR STE C
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7908
Practice Address - Country:US
Practice Address - Phone:317-508-0839
Practice Address - Fax:317-733-2829
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0554034A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist