Provider Demographics
NPI:1619548682
Name:SCHNEIDEWIND, ELIJAH ALEXANDER (LMBT, PT, CNC)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:ALEXANDER
Last Name:SCHNEIDEWIND
Suffix:
Gender:M
Credentials:LMBT, PT, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 JENKINS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NC
Mailing Address - Zip Code:28701-8709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 N MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753
Practice Address - Country:US
Practice Address - Phone:828-214-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21760225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist