Provider Demographics
NPI:1174633887
Name:SCHAFER, DOUGLAS
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SCHAFER
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 1:4760 OLIVE BRANCH RD
Mailing Address - Street 2:APT 1604
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7398
Mailing Address - Country:US
Mailing Address - Phone:407-420-1061
Mailing Address - Fax:
Practice Address - Street 1:1405 S ORANGE AVE
Practice Address - Street 2:STE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2154
Practice Address - Country:US
Practice Address - Phone:407-522-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18685225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA18685OtherLICENSE #