Provider Demographics
NPI:1861411829
Name:WALTER M SCHMIDT RPT, PA
Entity type:Organization
Organization Name:WALTER M SCHMIDT RPT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:856-227-3215
Mailing Address - Street 1:141 S BLACK HORSE PIKE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2975
Mailing Address - Country:US
Mailing Address - Phone:856-227-3215
Mailing Address - Fax:856-232-3190
Practice Address - Street 1:141 S BLACK HORSE PIKE
Practice Address - Street 2:SUITE #3
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2975
Practice Address - Country:US
Practice Address - Phone:856-227-3215
Practice Address - Fax:856-232-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00036200225100000X
PAPT001759L225100000X
NJ40QA00402300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000458043OtherBCBS
PA000458043OtherBCBS
PA0106235000OtherAETNA
NJ0106235000OtherAETNA
PA0106235000OtherAMERI HEALTH
NJ0106235000OtherAMERI HEALTH
PA0106235000OtherAMERI HEALTH