Provider Demographics
NPI:1447396288
Name:SCHMITZ, MATTHEW T (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:T
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 43RD ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3772
Mailing Address - Country:US
Mailing Address - Phone:616-608-9978
Mailing Address - Fax:
Practice Address - Street 1:1810 W WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2629
Practice Address - Country:US
Practice Address - Phone:616-225-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist