Provider Demographics
NPI:1801914486
Name:SCHAFER, MARY JOANN (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOANN
Last Name:SCHAFER
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 1:4116 BURNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1914
Mailing Address - Country:US
Mailing Address - Phone:419-478-3261
Mailing Address - Fax:
Practice Address - Street 1:1525 W MAUMEE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1899
Practice Address - Country:US
Practice Address - Phone:517-265-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist