Provider Demographics
NPI:1407003932
Name:MOEHRING-SCHMIDT, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MOEHRING-SCHMIDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MOEHRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2233 ACADEMY PL
Mailing Address - Street 2:STE 50
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1696
Mailing Address - Country:US
Mailing Address - Phone:719-475-0808
Mailing Address - Fax:719-475-8822
Practice Address - Street 1:2435 RESEARCH PKWY
Practice Address - Street 2:SUITE 255
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1070
Practice Address - Country:US
Practice Address - Phone:719-260-8400
Practice Address - Fax:719-260-8405
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 10579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO306381Medicare PIN