Provider Demographics
NPI:1245992593
Name:LEGACY PERFORMANCE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:LEGACY PERFORMANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:484-716-7663
Mailing Address - Street 1:345 TASHA LN
Mailing Address - Street 2:
Mailing Address - City:EAST FALLOWFIELD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:345 TASHA LN
Practice Address - Street 2:
Practice Address - City:EAST FALLOWFIELD TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:19320-4260
Practice Address - Country:US
Practice Address - Phone:484-716-7663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy