Provider Demographics
NPI:1336818814
Name:SCHONEBERGER, ALEXANDER (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SCHONEBERGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 HARBOR LN N APT 3-310
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-8841
Mailing Address - Country:US
Mailing Address - Phone:218-760-6208
Mailing Address - Fax:
Practice Address - Street 1:1107 HART BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8539
Practice Address - Country:US
Practice Address - Phone:763-295-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist