Provider Demographics
NPI:1205222494
Name:SCHOFER, ANTHONY LY (PTA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LY
Last Name:SCHOFER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CALLE AMANECER
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6278
Mailing Address - Country:US
Mailing Address - Phone:949-366-6785
Mailing Address - Fax:949-366-6470
Practice Address - Street 1:901 CALLE AMANECER
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6278
Practice Address - Country:US
Practice Address - Phone:949-366-6785
Practice Address - Fax:949-366-6470
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 10683225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant