Provider Demographics
NPI:1972621126
Name:SCHNECKENBERGER, MARTIN JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JAMES
Last Name:SCHNECKENBERGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 GARYPARK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5727
Mailing Address - Country:US
Mailing Address - Phone:626-444-5465
Mailing Address - Fax:
Practice Address - Street 1:120 N ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3115
Practice Address - Country:US
Practice Address - Phone:310-854-5949
Practice Address - Fax:310-854-6049
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist