Provider Demographics
NPI:1285000786
Name:SNYDER, JARED SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:SCOTT
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 E HUNT HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143
Mailing Address - Country:US
Mailing Address - Phone:480-568-4580
Mailing Address - Fax:480-568-4581
Practice Address - Street 1:1745 E HUNT HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143
Practice Address - Country:US
Practice Address - Phone:480-568-4580
Practice Address - Fax:480-568-4581
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10177A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant