Provider Demographics
NPI:1437503372
Name:SCHNEIDER, CHARLES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 LIPSCOMB ST APT 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3172
Mailing Address - Country:US
Mailing Address - Phone:432-556-4681
Mailing Address - Fax:
Practice Address - Street 1:2419 HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5158
Practice Address - Country:US
Practice Address - Phone:432-556-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1272726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist