Provider Demographics
NPI:1790760247
Name:SCHROEDER, RACHELLE B (PT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:B
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:BETH
Other - Last Name:RUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2714 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6715
Practice Address - Country:US
Practice Address - Phone:920-430-4760
Practice Address - Fax:920-430-4774
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIQ09049Medicare UPIN
WI073550097Medicare Oscar/Certification
WI073050046Medicare Oscar/Certification
WI073550101Medicare Oscar/Certification
WI100200052Medicare Oscar/Certification
WI802100031Medicare Oscar/Certification
WI002150211Medicare Oscar/Certification
WI073100048Medicare Oscar/Certification
WI075100097Medicare Oscar/Certification