MEDICARE: MRS. GINA MARIE SNYDER 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	225100000X	Physical Therapist	PT24516	CA

General Provider Information

NPI Number	:	1972528933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA MARIE SNYDER PT

Provider Business Mailing Address
First Line	:	617 IBIZA LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-1279
Country	:	US
Telephone Number	:	805-382-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 IBIZA LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-1279
Country	:	US
Telephone Number	:	805-382-2454
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/26/2010

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