Provider Demographics
NPI:1124397310
Name:SCHMIDT, KEITH ERIK (PT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ERIK
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:914 S SCHEUBER RD
Mailing Address - Street 2:PROVIDENCE CENTRALIA HOSPITAL
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-330-8720
Mailing Address - Fax:360-330-8737
Practice Address - Street 1:914 S SCHEUBER ROAD
Practice Address - Street 2:PROVIDENCE CENTRALIA HOSPITAL
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-330-8720
Practice Address - Fax:360-330-8737
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60224344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist