Basic Information
| Provider Information | |||||||||
| NPI: | 1043649684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOENBORN | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2341 LAKE VIEW AVE # 12 | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496968079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164274456 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2828 CONCORD ST | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496844618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319411200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5502002852 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.