Provider Demographics
NPI:1477256469
Name:SNIDER, DEBORAH SUE (PTA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SUE
Last Name:SNIDER
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 1:1724 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3233
Mailing Address - Country:US
Mailing Address - Phone:313-590-0578
Mailing Address - Fax:
Practice Address - Street 1:1724 ROSE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3233
Practice Address - Country:US
Practice Address - Phone:313-590-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001965225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant