Provider Demographics
NPI:1376689562
Name:SNACK, SANDRA QUAYLE (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:QUAYLE
Last Name:SNACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1555
Mailing Address - Country:US
Mailing Address - Phone:330-225-1897
Mailing Address - Fax:
Practice Address - Street 1:208 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1555
Practice Address - Country:US
Practice Address - Phone:330-225-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 0023762251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics