Provider Demographics
NPI:1447599873
Name:SCHNEIDER, SCOTT KELLY (PTA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KELLY
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 1:17810 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1654
Mailing Address - Country:US
Mailing Address - Phone:301-351-2931
Mailing Address - Fax:
Practice Address - Street 1:17810 BLUEBELL DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1654
Practice Address - Country:US
Practice Address - Phone:301-351-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2129225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant