Provider Demographics
NPI:1184772311
Name:SCHMITT, DUSTIN CADE (MPT, CSCS)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:CADE
Last Name:SCHMITT
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 E VAL VERDE ST
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5903
Mailing Address - Country:US
Mailing Address - Phone:208-542-6047
Mailing Address - Fax:
Practice Address - Street 1:285 W FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1751
Practice Address - Country:US
Practice Address - Phone:208-785-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID136533Medicare ID - Type UnspecifiedMEDICARE