Healthcare Provider Details

I. General information

NPI: 1073867032
Provider Name (Legal Business Name): LISA MARY SNYDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 N 16TH ST
TACOMA WA
98406-4701
US

IV. Provider business mailing address

4013 N. 16TH ST
TACOMA WA
98406-4701
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-9480
  • Fax:
Mailing address:
  • Phone: 253-759-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 00002968
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: