Healthcare Provider Details

I. General information

NPI: 1902579568
Provider Name (Legal Business Name): MILES PATRICK SCHNEEMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

IV. Provider business mailing address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

V. Phone/Fax

Practice location:
  • Phone: 406-823-6414
  • Fax: 406-823-6287
Mailing address:
  • Phone: 406-823-6414
  • Fax: 406-823-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-13030
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: