Provider Demographics
NPI:1598005696
Name:SNYDER, JESSICA GAYLE (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GAYLE
Last Name:SNYDER
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 1:3701 TRAKKER TRL
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8877
Mailing Address - Country:US
Mailing Address - Phone:949-682-6827
Mailing Address - Fax:
Practice Address - Street 1:3701 TRAKKER TRL
Practice Address - Street 2:UNIT 2E
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8877
Practice Address - Country:US
Practice Address - Phone:949-682-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11133225100000X
CA39917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist