MEDICARE: MS. MARTHA AMBROSE SNEARY 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	1100154	TX

General Provider Information

NPI Number	:	1538388814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA AMBROSE SNEARY PT

Provider Business Mailing Address
First Line	:	651 PECAN ST
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4548
Country	:	US
Telephone Number	:	830-964-3870
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 PECAN ST
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4548
Country	:	US
Telephone Number	:	830-964-3870
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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