Provider Demographics
NPI:1467684100
Name:SCHROEDER, DINA GAIL (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:GAIL
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44298
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98448-0298
Mailing Address - Country:US
Mailing Address - Phone:253-278-7100
Mailing Address - Fax:253-212-2144
Practice Address - Street 1:2727 138TH STREET CT E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-1844
Practice Address - Country:US
Practice Address - Phone:253-278-7100
Practice Address - Fax:253-212-2144
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42904225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist