Healthcare Provider Details

I. General information

NPI: 1801062914
Provider Name (Legal Business Name): GREGORY RALPH SNYDER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18791 FIFTEEN MILE RD
CLINTON TWP MI
48035-2503
US

IV. Provider business mailing address

18791 FIFTEEN MILE RD
CLINTON TWP MI
48035-2503
US

V. Phone/Fax

Practice location:
  • Phone: 586-790-2326
  • Fax: 586-790-2476
Mailing address:
  • Phone: 586-790-2326
  • Fax: 586-790-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: