Provider Demographics
NPI:1336362730
Name:SNYDER, MIRIAM R (PTA)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:R
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 1:5328 TRAILWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1573
Mailing Address - Country:US
Mailing Address - Phone:301-460-0186
Mailing Address - Fax:
Practice Address - Street 1:14409 GREENVIEW DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3293
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant