Provider Demographics
NPI:1912283276
Name:SCHMIDT, TERRA DAWN (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:DAWN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SATURN DR
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-7118
Mailing Address - Country:US
Mailing Address - Phone:928-776-2116
Mailing Address - Fax:
Practice Address - Street 1:1100 E SHELDON ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3220
Practice Address - Country:US
Practice Address - Phone:928-776-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer