Healthcare Provider Details

I. General information

NPI: 1982639662
Provider Name (Legal Business Name): MARK SNYDER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PLEASANTON AVE SUITE 200
PLEASANTON CA
94566-7052
US

IV. Provider business mailing address

5000 PLEASANTON AVE SUITE 200
PLEASANTON CA
94566-7052
US

V. Phone/Fax

Practice location:
  • Phone: 925-600-7033
  • Fax: 925-600-7035
Mailing address:
  • Phone: 925-600-7033
  • Fax: 925-600-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: