Provider Demographics
NPI:1740588219
Name:BOME, DONNA SCHNEIDER (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SCHNEIDER
Last Name:BOME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 HEARN DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:13110-3161
Mailing Address - Country:US
Mailing Address - Phone:315-636-7789
Mailing Address - Fax:
Practice Address - Street 1:3157 HEARN DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:NY
Practice Address - Zip Code:13110-3161
Practice Address - Country:US
Practice Address - Phone:315-636-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004531-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist