Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160004480 | IL |
NPI | 1003495599 |
---|---|
Provider Name | Terra Nicole Schnarre |
First Address | Brownstown, IL 62418-4444 |
Second Address | Brownstown, IL 62418-4444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2021 |
Last Update Date | 03/04/2021 |