Individual provider Active NPI

Rebecca Ellen Schrage, PTA

  • Physical Therapy Assistant
  • Edwardsville, IL
National Provider Identifier
1609124262
Registry record updated Aug 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
160.002194 Issued in IL
Practice address
401 St Mary Drive
Edwardsville, IL 62025-4276
Phone
(618) 692-1330
NPI assigned
Aug 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2012

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 160.002194 IL Primary

Addresses

Primary practice location

401 St Mary Drive
Edwardsville, IL 62025-4276

Mailing address

3801 Old Bruceville Road
Vincennes, IL 47591-3889
Phone (812) 886-4677

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
160.002194ILMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346198400000",
    "number": "1609124262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 OLD BRUCEVILLE ROAD",
            "city": "VINCENNES",
            "state": "IL",
            "postal_code": "475913889",
            "telephone_number": "812-886-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 ST MARY DRIVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620254276",
            "telephone_number": "618-692-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHRAGE",
        "first_name": "REBECCA",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2012-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.002194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; 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.