Individual
MS. LISA ANNE SCHROEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T., O.C.S.
Contact information
Practice address
7 EAST MEADOW LANE, OAK BLUFFS, MA 02557-0768
(310) 628-4885
(213) 477-2139
Mailing address
PO BOX 768, OAK BLUFFS, MA 02557-0768
(310) 628-4885
(213) 477-2139
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
8243
MA
2251X0800X
Orthopedic Physical Therapist
PT18189
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8243
PHYSICAL THERAPY LICENSE
MA
01
—
96-11-139-213-000
MEDICARE CCN #
MA
01
—
PT 18189
PHYSICAL THERAPY LICENSE
CA
Enumeration date
02/09/2007
Last updated
12/04/2012
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