Provider Demographics
NPI:1720097702
Name:SCHMIDT, EMILE GEORGE JR (PT)
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:GEORGE
Last Name:SCHMIDT
Suffix:JR
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 1:2 SHERIDAN SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7399
Mailing Address - Country:US
Mailing Address - Phone:423-246-8061
Mailing Address - Fax:423-246-8278
Practice Address - Street 1:2 SHERIDAN SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7399
Practice Address - Country:US
Practice Address - Phone:423-246-8061
Practice Address - Fax:423-246-8278
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650017Medicare PIN