Healthcare Provider Details

I. General information

NPI: 1447495171
Provider Name (Legal Business Name): RENEE CARLSON SNYDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE MARIE SNYDER PT

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WESTMINSTER RD
UTICA NY
13501-6426
US

IV. Provider business mailing address

19 WESTMINSTER RD
UTICA NY
13501
US

V. Phone/Fax

Practice location:
  • Phone: 315-733-5253
  • Fax:
Mailing address:
  • Phone: 315-733-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number015404-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: