Provider Demographics
NPI:1285857763
Name:SCHOONVELD, BRADLEY GENE (MPT,MTC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:GENE
Last Name:SCHOONVELD
Suffix:
Gender:M
Credentials:MPT,MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2601
Mailing Address - Country:US
Mailing Address - Phone:303-457-2022
Mailing Address - Fax:303-457-2320
Practice Address - Street 1:11325 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-2601
Practice Address - Country:US
Practice Address - Phone:303-457-2022
Practice Address - Fax:303-457-2320
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28606264Medicaid
CO28606264Medicaid