Provider Demographics
NPI:1306830849
Name:SCHRADER, JOHN WILLIAM (HSD, LAT, ATC)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:WILLIAM
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:HSD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 N BROWNCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1310
Mailing Address - Country:US
Mailing Address - Phone:812-856-4905
Mailing Address - Fax:812-856-2596
Practice Address - Street 1:1001 E. 17TH STREET, ASSEMBLY HALL
Practice Address - Street 2:SPORTS MEDICINE DEPARTMENT
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408
Practice Address - Country:US
Practice Address - Phone:812-855-4509
Practice Address - Fax:812-855-1810
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000281A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer