Provider Demographics
NPI:1285607929
Name:SHNEYDER, LAWRENCE MICHAEL (MPT, MTC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:SHNEYDER
Suffix:
Gender:M
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E NEW HAVEN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4576
Mailing Address - Country:US
Mailing Address - Phone:321-953-3991
Mailing Address - Fax:321-953-3951
Practice Address - Street 1:307 E NEW HAVEN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4576
Practice Address - Country:US
Practice Address - Phone:321-953-3991
Practice Address - Fax:321-953-3951
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPT18001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY918XOtherBC/BS
FLK9101Medicare ID - Type Unspecified