Provider Demographics
NPI:1790381812
Name:SCHRADER, SIERRA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
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 1:30A MOWBRAY AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8813
Mailing Address - Country:US
Mailing Address - Phone:508-505-1519
Mailing Address - Fax:
Practice Address - Street 1:30A MOWBRAY AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8813
Practice Address - Country:US
Practice Address - Phone:508-505-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist