Healthcare Provider Details

I. General information

NPI: 1588724330
Provider Name (Legal Business Name): SHANNON SNYDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 CANOPY GLN
MARIETTA GA
30066-1541
US

IV. Provider business mailing address

PO BOX 670207
MARIETTA GA
30066-0121
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-2480
  • Fax: 770-592-9431
Mailing address:
  • Phone: 770-517-2480
  • Fax: 770-592-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7462
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number7462
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: