Provider Demographics
NPI:1477840783
Name:SCHMIDT, ANGELA M (DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:26025 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2606
Practice Address - Country:US
Practice Address - Phone:248-663-1910
Practice Address - Fax:248-849-0190
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211135Medicare PIN