Provider Demographics
NPI:1629140488
Name:SCHAEFER, STEPHEN NORMAN (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:NORMAN
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 1:10505 19TH AVE SE
Mailing Address - Street 2:STE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:509-891-4198
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:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA185759OtherLABOR & INDUSTRIES
8801502Medicare ID - Type Unspecified