Individual
MARK C SCHODROF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
200 S OBRIEN ST, SEYMOUR, IN 47274-2440
(812) 522-9574
(812) 522-2576
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010558A
IN
225100000X
Physical Therapist
070013101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201038240
—
IN
01
—
P00943146
MEDICARE RAILROAD
IL
Enumeration date
09/26/2006
Last updated
08/12/2016
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