Provider Demographics
NPI:1326092446
Name:SCHAFER, JEREMY L (MPT, OCS, ECS)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:L
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MPT, OCS, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0157
Mailing Address - Country:US
Mailing Address - Phone:502-287-8122
Mailing Address - Fax:270-597-1020
Practice Address - Street 1:111 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171
Practice Address - Country:US
Practice Address - Phone:270-597-3757
Practice Address - Fax:270-597-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004222225100000X
KY122332251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00660001Medicare UPIN