1972538601 NPI number — MS. MARTHA DANIELS SCHOONMAKER P.T.

Table of content: MS. MARTHA DANIELS SCHOONMAKER P.T. (NPI 1972538601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972538601 NPI number — MS. MARTHA DANIELS SCHOONMAKER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOONMAKER
Provider First Name:
MARTHA
Provider Middle Name:
DANIELS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHOONMAKER
Provider Other First Name:
MARTY
Provider Other Middle Name:
DANIELS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972538601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAHOE CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96145-7109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-581-3884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1970 TWIN PEAKS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHOE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-581-3884
Provider Business Practice Location Address Fax Number:
530-581-3884
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  19709 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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