Provider Demographics
NPI:1104489541
Name:SNYDER, PHILIP MICHAEL
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 PALMETTO CIR S APT 802
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3518
Mailing Address - Country:US
Mailing Address - Phone:646-964-8152
Mailing Address - Fax:
Practice Address - Street 1:6902 PALMETTO CIR S APT 802
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3518
Practice Address - Country:US
Practice Address - Phone:646-964-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023544225X00000X
FLOT20484225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist