Healthcare Provider Details

I. General information

NPI: 1811616535
Provider Name (Legal Business Name): ABIGAIL SNYDER DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

IV. Provider business mailing address

15640 E NATIONAL RD
MARSHALL IL
62441-4293
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1345970
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70026036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: