Provider Demographics
NPI:1861737470
Name:SCHMIEDER, DANA LEE (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LEE
Last Name:SCHMIEDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEE
Other - Last Name:GEORGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8905 S COLD WATER DR
Mailing Address - Street 2:APT 1183
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1895
Mailing Address - Country:US
Mailing Address - Phone:920-445-3980
Mailing Address - Fax:
Practice Address - Street 1:500 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8333012-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist