Provider Demographics
NPI:1962826909
Name:SCHUBERT, JACQUELINE CARTER (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:CARTER
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12493 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8286
Mailing Address - Country:US
Mailing Address - Phone:208-412-6899
Mailing Address - Fax:
Practice Address - Street 1:12493 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8286
Practice Address - Country:US
Practice Address - Phone:208-412-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist