Individual provider Active NPI

Carol A Schmidt, PTA

  • Physical Therapy Assistant
  • Sturgeon Bay, WI
National Provider Identifier
1790893386
Registry record updated May 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
393-19 Issued in WI
Practice address
1300 Egg Harbor Rd Ste 108
Sturgeon Bay, WI 54235-1284
Phone
(920) 746-0410
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2010

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 393-19 WI Primary

Addresses

Primary practice location

1300 Egg Harbor Rd Ste 108
Sturgeon Bay, WI 54235-1284

Mailing address

10560 Applewood Dr
Sister Bay, WI 54234-9005
Phone (920) 854-4111

Other identifiers 1

IdentifierTypeStateIssuer
40266700MedicaidWI

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
393-19WIMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273795200000",
    "number": "1790893386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10560 APPLEWOOD DR",
            "city": "SISTER BAY",
            "state": "WI",
            "postal_code": "542349005",
            "telephone_number": "920-854-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 EGG HARBOR RD STE 108",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351284",
            "telephone_number": "920-746-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDT",
        "first_name": "CAROL",
        "middle_name": "A",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2010-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "393-19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40266700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgeon Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2010; 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.