Provider Demographics
NPI:1528065158
Name:SNYDER, JASON MICHAEL (RPT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHAEL
Last Name:SNYDER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:706 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-3825
Mailing Address - Country:US
Mailing Address - Phone:580-363-1111
Mailing Address - Fax:580-363-1116
Practice Address - Street 1:2005 N 14TH ST
Practice Address - Street 2:STE 111
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1952
Practice Address - Country:US
Practice Address - Phone:580-765-0101
Practice Address - Fax:580-765-3434
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKPT2540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist