Basic Information
Provider Information
NPI: 1356520761
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHROEDER
FirstName: CHRISTOPHER
MiddleName: ROBERT
NamePrefix: MR.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 43RD AVE STE 100
Address2:  
City: MOLINE
State: IL
PostalCode: 612658401
CountryCode: US
TelephoneNumber: 3097432070
FaxNumber: 3097432073
Practice Location
Address1: 3211 DIVISION ST STE 3
Address2:  
City: BURLINGTON
State: IA
PostalCode: 526011692
CountryCode: US
TelephoneNumber: 3197547899
FaxNumber: 3197547904
Other Information
ProviderEnumerationDate: 11/01/2007
LastUpdateDate: 03/30/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X02498IAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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