Provider Demographics
NPI:1548475676
Name:SCHMIDT, ALYSSA JOY (PTA)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:JOY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1553
Mailing Address - Country:US
Mailing Address - Phone:217-605-5507
Mailing Address - Fax:217-732-3101
Practice Address - Street 1:200 STAHLHUT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-5066
Practice Address - Country:US
Practice Address - Phone:217-605-5507
Practice Address - Fax:217-732-3101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003188225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant