Provider Demographics
NPI:1962774208
Name:SCHNEIDER, MICHAEL ALBERT (PTA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALBERT
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11195 MARSH WREN AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-3034
Mailing Address - Country:US
Mailing Address - Phone:352-848-4593
Mailing Address - Fax:
Practice Address - Street 1:12170 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5578
Practice Address - Country:US
Practice Address - Phone:352-232-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22071225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant