MEDICARE: ANNETTE KAY SCHWANDER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	116486	MO
2	225700000X	Massage Therapist	2002024931	MO

General Provider Information

NPI Number	:	1366623274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE KAY SCHWANDER PTA

Provider Business Mailing Address
First Line	:	21697 CHESTNUT RIDGE RD
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-8748
Country	:	US
Telephone Number	:	573-756-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SPRUCE ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1002
Country	:	US
Telephone Number	:	573-783-3993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/19/2007

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Directions to “ ANNETTE KAY SCHWANDER PTA” Practice Location

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