Provider Demographics
NPI:1144315078
Name:SCHUBERT, MENDI MICHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:MENDI
Middle Name:MICHELLE
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 HIGHWAY 81 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3917
Mailing Address - Country:US
Mailing Address - Phone:770-972-5159
Mailing Address - Fax:
Practice Address - Street 1:3890 HIGHWAY 81 SOUTH
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3917
Practice Address - Country:US
Practice Address - Phone:770-554-7977
Practice Address - Fax:770-554-4177
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP PIN 821337OtherBLUE CROSS BLUE SHIELD
GAGRP4351OtherMEDICARE
GA582654830OtherBLUE CROSS BLUE SHIELD
1386659894OtherPROMOTION PHYSICAL THERAPY FACILITY NPI
GA582654830OtherBLUE CROSS BLUE SHIELD