Healthcare Provider Details

I. General information

NPI: 1003495599
Provider Name (Legal Business Name): TERRA NICOLE SCHNARRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E 1475 AVE
BROWNSTOWN IL
62418-4444
US

IV. Provider business mailing address

1919 E 1475 AVE
BROWNSTOWN IL
62418-4444
US

V. Phone/Fax

Practice location:
  • Phone: 618-322-3646
  • Fax:
Mailing address:
  • Phone: 618-322-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160004480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: