Provider Demographics
NPI:1568445617
Name:SCHMIDT, THERESA ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:SCHMIDT
Suffix:
Gender:F
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:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-0908
Mailing Address - Country:US
Mailing Address - Phone:631-226-2191
Mailing Address - Fax:631-226-2191
Practice Address - Street 1:208 E ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6504
Practice Address - Country:US
Practice Address - Phone:631-226-2191
Practice Address - Fax:631-226-2191
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009087-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQC751QBQZ1Medicare UPIN