Provider Demographics
NPI:1578100962
Name:SCHNEIDER, ANDREW (STUDENT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WITHERELL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5350
Mailing Address - Country:US
Mailing Address - Phone:810-278-5591
Mailing Address - Fax:
Practice Address - Street 1:316 WITHERELL ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5350
Practice Address - Country:US
Practice Address - Phone:810-278-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer