Provider Demographics
NPI:1205265428
Name:SCHEURICH, THADIS WILLIAM
Entity type:Individual
Prefix:
First Name:THADIS
Middle Name:WILLIAM
Last Name:SCHEURICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E LUTZ RD
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-3211
Mailing Address - Country:US
Mailing Address - Phone:419-446-9144
Mailing Address - Fax:419-446-9146
Practice Address - Street 1:815 E LUTZ RD
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-3211
Practice Address - Country:US
Practice Address - Phone:419-446-9144
Practice Address - Fax:419-446-9146
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.09286225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant