Provider Demographics
NPI:1275821985
Name:SNYDER, TIMOTHY (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1:644 BLUEBIRD CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3301
Mailing Address - Country:US
Mailing Address - Phone:323-719-7140
Mailing Address - Fax:
Practice Address - Street 1:644 BLUEBIRD CANYON DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3301
Practice Address - Country:US
Practice Address - Phone:323-719-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist