Healthcare Provider Details

I. General information

NPI: 1942259429
Provider Name (Legal Business Name): ALEXIS SNYDER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 N M 37 HWY SUITE B
MIDDLEVILLE MI
49333-8166
US

IV. Provider business mailing address

4525 N M 37 HWY SUITE B
MIDDLEVILLE MI
49333-8166
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-4230
  • Fax: 269-795-4191
Mailing address:
  • Phone: 269-795-4230
  • Fax: 269-795-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010039
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: