Provider Demographics
NPI:1659687150
Name:SCHAEFER, ANDREW (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SCHAEFER
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 1:3021 FALLING WATERS BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6745
Mailing Address - Country:US
Mailing Address - Phone:847-356-2895
Mailing Address - Fax:847-356-2919
Practice Address - Street 1:3021 FALLING WATERS BLVD
Practice Address - Street 2:STE C
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6745
Practice Address - Country:US
Practice Address - Phone:847-356-2895
Practice Address - Fax:847-356-2919
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist