MEDICARE: MRS. LAURA F SNYDER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	013862	NY

General Provider Information

NPI Number	:	1134119134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA F SNYDER PT

Provider Business Mailing Address
First Line	:	417 GEYSER RD
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-3022
Country	:	US
Telephone Number	:	518-587-3256
Fax Number	:	518-587-5210

Provider Business Practice Location Address
First Line	:	417 GEYSER RD
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-3022
Country	:	US
Telephone Number	:	518-587-3256
Fax Number	:	518-587-5210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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