Healthcare Provider Details

I. General information

NPI: 1295160844
Provider Name (Legal Business Name): TARRYN N. SCHNEIDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARRYN BOLOGNANI ATC

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT ST
KEENE NH
03431
US

IV. Provider business mailing address

590 COURT ST
KEENE NH
03431-1719
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5400
  • Fax:
Mailing address:
  • Phone: 603-354-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number104.0098262
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1385
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: