Provider Demographics
NPI:1518216258
Name:SCHROEDER, GREGORY MAX (DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MAX
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4811
Mailing Address - Country:US
Mailing Address - Phone:312-236-0660
Mailing Address - Fax:312-236-1219
Practice Address - Street 1:20 N MICHIGAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4811
Practice Address - Country:US
Practice Address - Phone:312-236-0660
Practice Address - Fax:312-236-1219
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24098225100000X
IL070020794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist