Basic Information
| Provider Information | |||||||||
| NPI: | 1134246440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHILLER | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | JEFFREY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WEST 10TH STREET | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 4948 PENNELL ROAD | ||||||||
| Address2: | |||||||||
| City: | ASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190141867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104948730 | ||||||||
| FaxNumber: | 6104948730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT018580 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2834804000 | 01 | PA | IBC | OTHER | 102516046-0001 | 05 | PA | MEDICAID | 1134246440 | 01 | DE | DELAWARE PHYSICIANS CARE | OTHER | 3803007000 | 01 | DE | AMERIHEALTH | OTHER | 1955897 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30078483 | 01 | PA | KEYSTONE MERCY | OTHER | 1134246440 | 05 | DE | MEDICAID | 1134246440 | 01 | PA | BRAVO | OTHER |