Healthcare Provider Details

I. General information

NPI: 1548770027
Provider Name (Legal Business Name): MIHO SNYDER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

1703 GIUNTOLI LN
ARCATA CA
95521-4421
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-4950
  • Fax: 707-825-4951
Mailing address:
  • Phone: 707-825-4950
  • Fax: 707-825-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT35632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: