Provider Demographics
NPI:1376653238
Name:SCHAEFER, CORINNE G A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:G A
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:17700 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7580
Practice Address - Country:US
Practice Address - Phone:360-514-9383
Practice Address - Fax:360-514-0193
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00010189225100000X
OR06313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500630776Medicaid
WAP00742613OtherRR MEDICARE
WA8459661Medicaid
WA1376653238Medicaid
WA8459661Medicaid
OR500630776Medicaid
WA1376653238Medicaid