Provider Demographics
NPI:1619135001
Name:SCHMIDT, SCOTT ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:SCHMIDT
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:CMR 415
Mailing Address - Street 2:BOX 4989
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114
Mailing Address - Country:US
Mailing Address - Phone:314-475-7118
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist