Healthcare Provider Details

I. General information

NPI: 1134528276
Provider Name (Legal Business Name): AMANDA NICHOLE SNYDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NICHOLE SCHULLER DPT

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 BOARDMAN POLAND RD SUITE 12B
BOARDMAN OH
44512-5129
US

IV. Provider business mailing address

5300 DERRY ST 2ND FLOOR
HARRISBURG PA
17111-3576
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-9448
  • Fax: 330-729-9450
Mailing address:
  • Phone: 717-839-2110
  • Fax: 717-565-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016469
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023758
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: