Provider Demographics
NPI:1508938333
Name:SCHAEFER, ERIC JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOSEPH
Last Name:SCHAEFER
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 1:4631 WHITMAN LN SE
Mailing Address - Street 2:STE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2250
Mailing Address - Country:US
Mailing Address - Phone:509-255-9646
Mailing Address - Fax:
Practice Address - Street 1:12410 E SINTO AVE
Practice Address - Street 2:STE. 203
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2199
Practice Address - Country:US
Practice Address - Phone:509-927-7827
Practice Address - Fax:509-928-7556
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8346090Medicaid
WA0181043OtherLABOR & INDUSTRIES
WA8346090Medicaid