Provider Demographics
NPI:1174650774
Name:SCHEFFLER, TABITHA LOUISE (MPT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:LOUISE
Last Name:SCHEFFLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E HWY 72
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-9620
Mailing Address - Country:US
Mailing Address - Phone:573-783-8001
Mailing Address - Fax:573-783-7045
Practice Address - Street 1:803 E HWY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-9620
Practice Address - Country:US
Practice Address - Phone:573-783-8001
Practice Address - Fax:573-783-7045
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487464802Medicaid