Provider Demographics
NPI:1467401463
Name:SCHAFER, RICHARD KENDEL (MPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KENDEL
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ROHRER LOOP
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-4365
Mailing Address - Country:US
Mailing Address - Phone:360-333-9103
Mailing Address - Fax:
Practice Address - Street 1:CASCADE PHYSICAL THERAPY & SPORTS CLINIC
Practice Address - Street 2:210 FERRY ST
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1411
Practice Address - Country:US
Practice Address - Phone:360-856-4216
Practice Address - Fax:360-856-4217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0207844OtherLABOR & INDUSTRIES
WA8859488Medicare ID - Type Unspecified