Provider Demographics
NPI:1972065977
Name:SCHMIDT, CHENOA RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHENOA
Middle Name:RAE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 RANCH ROAD 1631
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-6044
Mailing Address - Country:US
Mailing Address - Phone:830-889-4835
Mailing Address - Fax:
Practice Address - Street 1:402 W WINDCREST ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4465
Practice Address - Country:US
Practice Address - Phone:830-997-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5560225100000X
TX1404937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty