Provider Demographics
NPI:1235922055
Name:SCHMIDT, TREY ARCHER (PTA)
Entity type:Individual
Prefix:
First Name:TREY
Middle Name:ARCHER
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8349 W BLACKBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7864
Mailing Address - Country:US
Mailing Address - Phone:208-982-1295
Mailing Address - Fax:208-982-1295
Practice Address - Street 1:10790 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1329
Practice Address - Country:US
Practice Address - Phone:208-322-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8171167208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation