Provider Demographics
NPI:1366623274
Name:SCHWANDER, ANNETTE KAY (PTA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:KAY
Last Name:SCHWANDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21697 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-8748
Mailing Address - Country:US
Mailing Address - Phone:573-756-8409
Mailing Address - Fax:
Practice Address - Street 1:105 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1002
Practice Address - Country:US
Practice Address - Phone:573-783-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116486225200000X
MO2002024931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant