Provider Demographics
NPI:1265831762
Name:SCHROETKE, SAMUEL S (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:SCHROETKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 SE OAK ST.
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-844-6565
Mailing Address - Fax:503-844-4225
Practice Address - Street 1:862 SE OAK ST.
Practice Address - Street 2:SUITE 2A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-844-6565
Practice Address - Fax:503-844-4225
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist