Basic Information
| Provider Information | |||||||||
| NPI: | 1932715612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWENTNER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | AARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2311 OAKWAY TER | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974015109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038777776 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 CRATER LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975046505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417737717 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2020 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 9873 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.