Provider Demographics
NPI:1326360124
Name:SCHAEFER, BRUCE W (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:W
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 GOODPASTURE ISLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2278
Mailing Address - Country:US
Mailing Address - Phone:541-556-7148
Mailing Address - Fax:
Practice Address - Street 1:321 GOODPASTURE ISLAND RD STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2278
Practice Address - Country:US
Practice Address - Phone:541-556-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist