MEDICARE: JESSICA SNIDER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	28574	FL

General Provider Information

NPI Number	:	1942736236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SNIDER PT

Provider Business Mailing Address
First Line	:	9151 BUTTERFLY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8312
Country	:	US
Telephone Number	:	937-267-6646
Fax Number	:

Provider Business Practice Location Address
First Line	:	9151 BUTTERFLY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8312
Country	:	US
Telephone Number	:	937-267-6646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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