Provider Demographics
NPI:1740965391
Name:SCHRIVER, MIKAELA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:
Last Name:SCHRIVER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5719
Mailing Address - Country:US
Mailing Address - Phone:417-259-2492
Mailing Address - Fax:
Practice Address - Street 1:916 GOBLIN DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8885
Practice Address - Country:US
Practice Address - Phone:417-259-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028508225100000X
AR5297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist