Individual provider Active NPI

Daniel Schmidtke, PTA

  • Physical Therapy Assistant
  • Saint Louis, MO
National Provider Identifier
1255723953
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
2011040564 Issued in MO
Practice address
11960 Westline Industrial Dr
Suite 201
Saint Louis, MO 63146-3209
Phone
(314) 819-0480
NPI assigned
Mar 4, 2015
Last updated
Mar 4, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2011040564 MO Primary

Addresses

Primary practice location

11960 Westline Industrial Dr
Suite 201
Saint Louis, MO 63146-3209

Mailing address

11960 Westline Industrial Dr
Suite 201
Saint Louis, MO 63146-3209

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2011040564MOMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Supplemental Health Care Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1255723953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR",
            "address_2": "SUITE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR",
            "address_2": "SUITE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "314-819-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDTKE",
        "first_name": "DANIEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2011040564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.