Healthcare Provider Details

I. General information

NPI: 1912615659
Provider Name (Legal Business Name): BRANDON SCHNEIDER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11630 STUDT AVE STE 200
CREVE COEUR MO
63141-7394
US

IV. Provider business mailing address

6 CROSS CREEK LN
O FALLON MO
63366-4736
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-8248
  • Fax: 314-733-9101
Mailing address:
  • Phone: 314-308-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2022041266
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: