Provider Demographics
NPI:1982639662
Name:SNYDER, MARK (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 PLEASANTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7052
Mailing Address - Country:US
Mailing Address - Phone:925-600-7033
Mailing Address - Fax:925-600-7035
Practice Address - Street 1:5000 PLEASANTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7052
Practice Address - Country:US
Practice Address - Phone:925-600-7033
Practice Address - Fax:925-600-7035
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT87880OtherBLUE SHIELD
CA00PT87880OtherBLUE SHIELD