Provider Demographics
NPI:1134528276
Name:SNYDER, AMANDA NICHOLE (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHOLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICHOLE
Other - Last Name:SCHULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:813 BOARDMAN POLAND RD
Practice Address - Street 2:SUITE 12B
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5129
Practice Address - Country:US
Practice Address - Phone:330-729-9448
Practice Address - Fax:330-729-9450
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016469225100000X
PAPT023758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist