Healthcare Provider Details

I. General information

NPI: 1497241046
Provider Name (Legal Business Name): LISA JOAN SNYDER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 DESOTO RD
SARASOTA FL
34235-3607
US

IV. Provider business mailing address

4942 80TH AVENUE PLZ E
SARASOTA FL
34243-4301
US

V. Phone/Fax

Practice location:
  • Phone: 941-256-2609
  • Fax:
Mailing address:
  • Phone: 941-284-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: