Healthcare Provider Details

I. General information

NPI: 1750015467
Provider Name (Legal Business Name): JOHN SNYDER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 DORCHESTER RD
NORTH CHARLESTON SC
29420-7328
US

IV. Provider business mailing address

8626 DORCHESTER RD
NORTH CHARLESTON SC
29420-7328
US

V. Phone/Fax

Practice location:
  • Phone: 843-323-0174
  • Fax: 888-856-3189
Mailing address:
  • Phone: 843-323-0174
  • Fax: 888-856-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11032
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: