Provider Demographics
NPI:1912615659
Name:SCHNEIDER, BRANDON (PTA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CROSS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4736
Mailing Address - Country:US
Mailing Address - Phone:314-308-6266
Mailing Address - Fax:
Practice Address - Street 1:11630 STUDT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7394
Practice Address - Country:US
Practice Address - Phone:636-244-8248
Practice Address - Fax:314-733-9101
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022041266225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant