Provider Demographics
NPI:1124677646
Name:SCHNEIDER-HARDING, MACKENZIE (PT, DPT, MS, CSCS)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:SCHNEIDER-HARDING
Suffix:
Gender:M
Credentials:PT, DPT, MS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1906
Mailing Address - Country:US
Mailing Address - Phone:208-866-2575
Mailing Address - Fax:
Practice Address - Street 1:3350 E BIRCH ST STE 160
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6218
Practice Address - Country:US
Practice Address - Phone:714-528-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2971962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic