Healthcare Provider Details

I. General information

NPI: 1467110403
Provider Name (Legal Business Name): JENNIFER LYNN SNYDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 1/2 S MAIN ST
NORWOOD NY
13668-3168
US

IV. Provider business mailing address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

V. Phone/Fax

Practice location:
  • Phone: 315-353-6618
  • Fax: 315-353-4620
Mailing address:
  • Phone: 518-546-7151
  • Fax: 518-546-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: