Provider Demographics
NPI:1659714202
Name:SCHMIDT, MICHAEL T (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 CORPORAL KENNEDY ST
Mailing Address - Street 2:APT# L2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1456
Mailing Address - Country:US
Mailing Address - Phone:516-578-9912
Mailing Address - Fax:
Practice Address - Street 1:1875 CORPORAL KENNEDY ST
Practice Address - Street 2:APT# L2
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1456
Practice Address - Country:US
Practice Address - Phone:516-578-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer