Provider Demographics
NPI:1780685032
Name:SCHMIDT, BRYAN JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JAMES
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:BRYAN
Other - Middle Name:JAMES
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, CHT
Mailing Address - Street 1:4150 REGENTS PARK ROW
Mailing Address - Street 2:#345
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9102
Mailing Address - Country:US
Mailing Address - Phone:858-677-9700
Mailing Address - Fax:858-677-9770
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:#345
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9102
Practice Address - Country:US
Practice Address - Phone:858-677-9700
Practice Address - Fax:858-677-9770
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11570447OtherCAQH
CAZZZ13110ZOtherBLUE SHIELD OF CALIFORNIA
CAWPTZ8061AMedicare ID - Type Unspecified