Provider Demographics
NPI:1003495599
Name:SCHNARRE, TERRA NICOLE
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:NICOLE
Last Name:SCHNARRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E 1475 AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62418-4444
Mailing Address - Country:US
Mailing Address - Phone:618-322-3646
Mailing Address - Fax:
Practice Address - Street 1:1919 E 1475 AVE
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62418-4444
Practice Address - Country:US
Practice Address - Phone:618-322-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004480225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant