Provider Demographics
NPI:1437217957
Name:SNYDER, JEREMY (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
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 1:525 N CASCADE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3308
Mailing Address - Country:US
Mailing Address - Phone:719-381-4359
Mailing Address - Fax:719-381-4359
Practice Address - Street 1:525 N CASCADE AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3308
Practice Address - Country:US
Practice Address - Phone:719-381-4359
Practice Address - Fax:719-381-4359
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803850Medicare PIN
CO803849Medicare PIN