Provider Demographics
NPI:1790058790
Name:SCHAEFER, COLLEEN ANNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANNE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 MONTGOMERY RD
Mailing Address - Street 2:STE 125
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-755-3392
Mailing Address - Fax:
Practice Address - Street 1:10700 MONTGOMERY RD STE 125
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-3255
Practice Address - Country:US
Practice Address - Phone:513-755-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-008714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist