Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501006756 | MI |
NPI | 1386144673 |
---|---|
Provider Name | Peter Anthony Schaub |
First Address | Gaylord, MI 49735-9304 |
Second Address | Gaylord, MI 49735-9304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2018 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501006756 | STATE PT LICENSE (01) | MI |