Provider Demographics
NPI:1477886687
Name:SCHROEDER, JARED LEE (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:LEE
Last Name:SCHROEDER
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:
Practice Address - Street 1:14665 GALAXIE AVE STE 320
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4538
Practice Address - Country:US
Practice Address - Phone:952-892-6777
Practice Address - Fax:952-892-0792
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017406225100000X
MN8676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070017406OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION
MN650002667Medicare PIN