Provider Demographics
NPI:1093050056
Name:SNYDER, STEVEN GARY (DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GARY
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E 2ND ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3779
Mailing Address - Fax:909-620-1048
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 4
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3779
Practice Address - Fax:909-620-1048
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 39690OtherCA DPT LICENSE