Provider Demographics
NPI:1578585907
Name:SNYDER, AMY T (PT MPT DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PT MPT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 S GREEN BAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4410
Mailing Address - Country:US
Mailing Address - Phone:262-321-0240
Mailing Address - Fax:262-321-0242
Practice Address - Street 1:241 N BROADWAY STE 403
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5819
Practice Address - Country:US
Practice Address - Phone:414-446-9291
Practice Address - Fax:414-446-8618
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9871-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40372400Medicaid
WI40372400Medicaid