Provider Demographics
NPI:1881669380
Name:SCHNEIDER, JUTTA A (MSPT)
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:A
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 FIR ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-3515
Mailing Address - Country:US
Mailing Address - Phone:206-860-3746
Mailing Address - Fax:
Practice Address - Street 1:1917 FIR ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-3515
Practice Address - Country:US
Practice Address - Phone:206-860-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000067232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA161180OtherLABOR & INDUSTRIES PROV #
WA161180OtherLABOR & INDUSTRIES PROV #
WA8406662Medicaid