Provider Demographics
NPI:1326506478
Name:SCHROEDER, STACIA ROBINSON (DPT)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:ROBINSON
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:102 MONASTERIO CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2139
Mailing Address - Country:US
Mailing Address - Phone:510-368-5719
Mailing Address - Fax:
Practice Address - Street 1:102 MONASTERIO CT
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2139
Practice Address - Country:US
Practice Address - Phone:510-368-5719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT207262251S0007X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports