Healthcare Provider Details

I. General information

NPI: 1356700637
Provider Name (Legal Business Name): EVAN SNYDER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 OGLETOWN STANTON RD STE B
NEWARK DE
19713-4183
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 302-894-1800
  • Fax: 302-894-1811
Mailing address:
  • Phone: 630-296-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003446
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: