Provider Demographics
NPI:1790721439
Name:SCHAEFER, JONATHAN J (LPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:J
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 E. MEXICO AVE., SUITE 210
Mailing Address - Street 2:CENTERPOINT 1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3940
Mailing Address - Country:US
Mailing Address - Phone:303-691-3733
Mailing Address - Fax:303-691-1142
Practice Address - Street 1:3900 E. MEXICO AVE., SUITE 210
Practice Address - Street 2:CENTERPOINT 1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3940
Practice Address - Country:US
Practice Address - Phone:303-691-3733
Practice Address - Fax:303-691-1142
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL070009821208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08220357OtherBCBS IL GRP#
IL900068033OtherTAX ID#
IL900068033OtherTAX ID#