Provider Demographics
NPI:1306485826
Name:SCHOONOVER, ANGEL (ATC, PTA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:SCHOONOVER
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 OWLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODHULL
Mailing Address - State:NY
Mailing Address - Zip Code:14898-9668
Mailing Address - Country:US
Mailing Address - Phone:607-684-0272
Mailing Address - Fax:
Practice Address - Street 1:1 ACADEMIC DRIVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-962-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012389225200000X
PATE012375225200000X
NY0044962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant