Provider Demographics
NPI:1972538601
Name:SCHOONMAKER, MARTHA DANIELS (PT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:DANIELS
Last Name:SCHOONMAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARTY
Other - Middle Name:DANIELS
Other - Last Name:SCHOONMAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 7109
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-7109
Mailing Address - Country:US
Mailing Address - Phone:530-581-3884
Mailing Address - Fax:
Practice Address - Street 1:1970 TWIN PEAKS
Practice Address - Street 2:
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-581-3884
Practice Address - Fax:530-581-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT197090Medicare ID - Type UnspecifiedPHYSICAL THERAPIST