Provider Demographics
NPI:1366648263
Name:SNYDER, KERRY ANNE (PTA)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:ANNE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5360
Mailing Address - Country:US
Mailing Address - Phone:310-339-7331
Mailing Address - Fax:901-339-7331
Practice Address - Street 1:535 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3309
Practice Address - Country:US
Practice Address - Phone:310-339-7331
Practice Address - Fax:901-339-7331
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 766225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant