Provider Demographics
NPI:1336193382
Name:SCHMERSAHL, JOSEPH (MPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SCHMERSAHL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 DEWEY AVE NW
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2548
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:605 E BOONESLICK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2127
Practice Address - Country:US
Practice Address - Phone:636-456-6350
Practice Address - Fax:636-456-6084
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12434978OtherCAQH
MOP00370060OtherRAILROAD MEDICARE
MO221851643Medicare PIN