Provider Demographics
NPI:1518097823
Name:SCHAFER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SCHAFER PHYSICAL THERAPY, LLC
Other - Org Name:SMITH'S GROVE PHYSCIAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:502-287-8122
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0157
Mailing Address - Country:US
Mailing Address - Phone:502-287-8115
Mailing Address - Fax:
Practice Address - Street 1:520 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9001
Practice Address - Country:US
Practice Address - Phone:270-597-3757
Practice Address - Fax:270-597-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00660Medicare UPIN