Provider Demographics
NPI:1265488415
Name:SNYDER, DONALD (PT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 N ALVERNON WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6140
Mailing Address - Country:US
Mailing Address - Phone:520-975-6734
Mailing Address - Fax:520-323-6364
Practice Address - Street 1:4430 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6140
Practice Address - Country:US
Practice Address - Phone:520-975-6734
Practice Address - Fax:520-323-6364
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26364Medicare ID - Type Unspecified
AZR09585Medicare UPIN