Provider Demographics
NPI:1215229208
Name:SCHMIDT, BRETTA (LMT)
Entity Type:Individual
Prefix:
First Name:BRETTA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34705 N NEWPORT HWY STE C
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-7811
Mailing Address - Country:US
Mailing Address - Phone:509-292-8016
Mailing Address - Fax:
Practice Address - Street 1:34705 N NEWPORT HWY STE C
Practice Address - Street 2:
Practice Address - City:CHATTAROY
Practice Address - State:WA
Practice Address - Zip Code:99003-7811
Practice Address - Country:US
Practice Address - Phone:509-292-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist