Provider Demographics
NPI:1447659552
Name:SCHNEIDER, EVAN (DPT)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 CHEROKEE AVE SE STE 204
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3260
Mailing Address - Country:US
Mailing Address - Phone:470-815-0587
Mailing Address - Fax:678-228-1478
Practice Address - Street 1:464 CHEROKEE AVE SE STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3260
Practice Address - Country:US
Practice Address - Phone:470-815-0587
Practice Address - Fax:678-228-1478
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60665607225100000X
NCP150962251S0007X
GAPT0153622251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist