Provider Demographics
NPI:1659515377
Name:SCHMIDT, RESA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:RESA
Middle Name:MARIE
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 1:19150 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3058
Mailing Address - Country:US
Mailing Address - Phone:952-922-7615
Mailing Address - Fax:
Practice Address - Street 1:8690 EAGLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1284
Practice Address - Country:US
Practice Address - Phone:952-808-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist