Healthcare Provider Details

I. General information

NPI: 1841092954
Provider Name (Legal Business Name): GARRETT LAVAR SNYDER DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N OAK ST
BLACKFOOT ID
83221-1757
US

IV. Provider business mailing address

1411 FALLS AVE E STE 401
TWIN FALLS ID
83301-3455
US

V. Phone/Fax

Practice location:
  • Phone: 208-684-2444
  • Fax: 208-994-6714
Mailing address:
  • Phone: 208-684-2444
  • Fax: 208-994-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9971655
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: