Provider Demographics
NPI:1457313710
Name:SCHWABENBAUER, TED J (PT)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:SCHWABENBAUER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 OLD HIGHWAY 8 NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2778
Mailing Address - Country:US
Mailing Address - Phone:651-604-0249
Mailing Address - Fax:651-604-0248
Practice Address - Street 1:5440 E SOUTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2779
Practice Address - Country:US
Practice Address - Phone:480-641-3533
Practice Address - Fax:480-641-3935
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ929838Medicaid