Healthcare Provider Details

I. General information

NPI: 1285000786
Provider Name (Legal Business Name): JARED SCOTT SNYDER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 E HUNT HWY SUITE 103
SAN TAN VALLEY AZ
85143
US

IV. Provider business mailing address

1745 E HUNT HWY SUITE 103
SAN TAN VALLEY AZ
85143
US

V. Phone/Fax

Practice location:
  • Phone: 480-568-4580
  • Fax: 480-568-4581
Mailing address:
  • Phone: 480-568-4580
  • Fax: 480-568-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10177A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: