MEDICARE: MS. JORGA SNYDER DURAN PTA

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	174400000X	Specialist	PTA21026	FL

General Provider Information

NPI Number	:	1972790517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JORGA SNYDER DURAN PTA

Provider Business Mailing Address
First Line	:	214 SE TRIBBLE ST
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0108
Country	:	US
Telephone Number	:	386-755-7263
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 SE TRIBBLE ST
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0108
Country	:	US
Telephone Number	:	386-755-7263
Fax Number	:

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

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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