Provider Demographics
NPI:1366672487
Name:SCHMIDT, JEREMY WAYNE (DPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:WAYNE
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3205
Mailing Address - Country:US
Mailing Address - Phone:913-461-7579
Mailing Address - Fax:303-663-8289
Practice Address - Street 1:4284 TRAIL BOSS DR
Practice Address - Street 2:STE 130
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7521
Practice Address - Country:US
Practice Address - Phone:303-663-8289
Practice Address - Fax:303-663-8289
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC477678Medicare UPIN