Provider Demographics
NPI:1831692813
Name:SCHONBACHLER, KEN (MPT, MBA)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:SCHONBACHLER
Suffix:
Gender:M
Credentials:MPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16371-1605
Mailing Address - Country:US
Mailing Address - Phone:814-563-6403
Mailing Address - Fax:814-563-6725
Practice Address - Street 1:709 ROUSE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16371-1605
Practice Address - Country:US
Practice Address - Phone:814-563-6750
Practice Address - Fax:814-563-6751
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011627L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT011627LOtherPHYSICAL THERAPY LICENSE