Provider Demographics
NPI:1982636940
Name:SCHAACK, MICHAEL GEOFFREY (MSPT FAAOMPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GEOFFREY
Last Name:SCHAACK
Suffix:
Gender:M
Credentials:MSPT FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 EVAN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765
Mailing Address - Country:US
Mailing Address - Phone:916-435-0269
Mailing Address - Fax:
Practice Address - Street 1:1620 LEAD HILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-789-1111
Practice Address - Fax:916-789-1304
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist