Healthcare Provider Details

I. General information

NPI: 1588015853
Provider Name (Legal Business Name): PAUL SNYDER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PROVIDENCE MINE RD SUITE 206
NEVADA CITY CA
95959-2947
US

IV. Provider business mailing address

12814 BANNER LAVA CAP RD
NEVADA CITY CA
95959-9614
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-8100
  • Fax: 530-265-8112
Mailing address:
  • Phone: 530-274-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: