Provider Demographics
NPI:1336239110
Name:SCHNEIDER, MARY P (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 POND ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1330
Mailing Address - Country:US
Mailing Address - Phone:167-177-0416
Mailing Address - Fax:
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:161-777-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCY68000OtherBCBS OF MASSACHUSETTS
SCY68000OtherBCBS OF MASSACHUSETTS