Provider Demographics
NPI:1356006050
Name:SCHAAL PHYSICAL THERAPY AND FITNESS
Entity Type:Organization
Organization Name:SCHAAL PHYSICAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHAAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:719-346-6050
Mailing Address - Street 1:334 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-2414
Mailing Address - Country:US
Mailing Address - Phone:719-346-6050
Mailing Address - Fax:719-346-5509
Practice Address - Street 1:334 S 13TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-2414
Practice Address - Country:US
Practice Address - Phone:719-346-6050
Practice Address - Fax:719-346-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54535743Medicaid