Provider Demographics
NPI:1962662114
Name:SNYDER, JESSICA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SNYDER
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 1:350 JACKSON TWP RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:PA
Mailing Address - Zip Code:17830-6958
Mailing Address - Country:US
Mailing Address - Phone:570-590-1364
Mailing Address - Fax:
Practice Address - Street 1:44 DONALDSON RD
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:PA
Practice Address - Zip Code:17981-1424
Practice Address - Country:US
Practice Address - Phone:570-695-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000002225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant