Provider Demographics
NPI:1619304854
Name:SNYDER, THOMAS GENE (PTA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GENE
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH FIRST ST
Mailing Address - Street 2:STE 1800
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1959
Mailing Address - Country:US
Mailing Address - Phone:818-558-7252
Mailing Address - Fax:818-558-7312
Practice Address - Street 1:101 SOUTH FIRST ST
Practice Address - Street 2:STE 1800
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1959
Practice Address - Country:US
Practice Address - Phone:818-558-7252
Practice Address - Fax:818-558-7312
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10165225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant