Healthcare Provider Details

I. General information

NPI: 1225723067
Provider Name (Legal Business Name): ERIC A SNYDER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34901 DIVISION RD
RICHMOND MI
48062-1559
US

IV. Provider business mailing address

34901 DIVISION RD
RICHMOND MI
48062-1559
US

V. Phone/Fax

Practice location:
  • Phone: 586-727-7562
  • Fax:
Mailing address:
  • Phone: 586-727-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003825
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: