Healthcare Provider Details

I. General information

NPI: 1619482049
Provider Name (Legal Business Name): EMILY ROSE SNYDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ROSE ROTH DPT

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 MAHONING AVE FL 2
AUSTINTOWN OH
44515-2366
US

IV. Provider business mailing address

5533 MAHONING AVE FL 2
AUSTINTOWN OH
44515-2366
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-0094
  • Fax: 330-799-8303
Mailing address:
  • Phone: 330-799-0094
  • Fax: 330-799-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017083
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: