Provider Demographics
NPI:1063582617
Name:SNYDER, JAMES PATRICK (PTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 FREDERICKSBURG DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2650
Mailing Address - Country:US
Mailing Address - Phone:937-275-1938
Mailing Address - Fax:
Practice Address - Street 1:649 FREDERICKSBURG DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2650
Practice Address - Country:US
Practice Address - Phone:937-275-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 05441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant