Provider Demographics
NPI:1215453790
Name:SCHNEIDMAN, ALISA CAROLYN (LMT)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:CAROLYN
Last Name:SCHNEIDMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4805
Mailing Address - Country:US
Mailing Address - Phone:302-740-1364
Mailing Address - Fax:
Practice Address - Street 1:8103 GOVERNOR PRINTZ BLVD
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2912
Practice Address - Country:US
Practice Address - Phone:302-740-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0003979225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist