Healthcare Provider Details

I. General information

NPI: 1063582617
Provider Name (Legal Business Name): JAMES PATRICK SNYDER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 FREDERICKSBURG DR
DAYTON OH
45415-2650
US

IV. Provider business mailing address

649 FREDERICKSBURG DR
DAYTON OH
45415-2650
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-1938
  • Fax:
Mailing address:
  • Phone: 937-275-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 05441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: