Provider Demographics
NPI:1750738050
Name:SCHMIDT, JESSICA L (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:SCHMIDT
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 1:7056 STATE ROUTE 412
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-9737
Mailing Address - Country:US
Mailing Address - Phone:419-202-5915
Mailing Address - Fax:
Practice Address - Street 1:7056 STATE ROUTE 412
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-9737
Practice Address - Country:US
Practice Address - Phone:419-202-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty