Healthcare Provider Details

I. General information

NPI: 1740588219
Provider Name (Legal Business Name): DONNA SCHNEIDER BOME PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 HEARN DR
MARIETTA NY
13110-3161
US

IV. Provider business mailing address

3157 HEARN DR
MARIETTA NY
13110-3161
US

V. Phone/Fax

Practice location:
  • Phone: 315-636-7789
  • Fax:
Mailing address:
  • Phone: 315-636-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number004531-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: