Provider Demographics
NPI:1548698756
Name:SCHAAL PHYSICAL THERAPY AND FITNESS
Entity type:Organization
Organization Name:SCHAAL PHYSICAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHAAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-346-6050
Mailing Address - Street 1:942 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1815
Mailing Address - Country:US
Mailing Address - Phone:719-346-6050
Mailing Address - Fax:719-346-5509
Practice Address - Street 1:942 ROSE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1815
Practice Address - Country:US
Practice Address - Phone:719-346-6050
Practice Address - Fax:719-346-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-25
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0011362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54535743Medicaid