Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2012004502 | MO |
NPI | 1003185976 |
---|---|
Provider Name | Katie M Schroeder |
First Address | Quincy, IL 62301-3708 |
Second Address | Quincy, IL 62301-3708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 16/01/2017 |