Provider Demographics
NPI:1184763732
Name:SCHOWENGERDT, STEPHAN LOUIS (RPT)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:LOUIS
Last Name:SCHOWENGERDT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 GOLF ST
Mailing Address - Street 2:BOX 37
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-1462
Mailing Address - Country:US
Mailing Address - Phone:816-230-3363
Mailing Address - Fax:816-230-7206
Practice Address - Street 1:609 GOLF ST
Practice Address - Street 2:BOX 37
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1462
Practice Address - Country:US
Practice Address - Phone:816-230-3363
Practice Address - Fax:816-230-7206
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist