Provider Demographics
NPI:1013161934
Name:MARTHA DANIELS SCHOONMAKER
Entity Type:Organization
Organization Name:MARTHA DANIELS SCHOONMAKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:DANIELS
Authorized Official - Last Name:SCHOONMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:530-581-3884
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 DR
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19709261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013161934OtherMEDICARE NPI
CABZ522AOtherMEDICARE PTAN
CA1972538601OtherMEDICARE NPI - INDIVIDUAL
CA1972538601OtherMEDICARE NPI - INDIVIDUAL