Provider Demographics
NPI:1023664018
Name:SCHROEDER, TERESA LOUISE (PT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 SE FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8742
Mailing Address - Country:US
Mailing Address - Phone:773-562-2778
Mailing Address - Fax:
Practice Address - Street 1:2401 E 8TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-1717
Practice Address - Country:US
Practice Address - Phone:515-262-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03281208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty