Provider Demographics
NPI:1801062914
Name:SNYDER, GREGORY RALPH (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RALPH
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18791 FIFTEEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2503
Mailing Address - Country:US
Mailing Address - Phone:586-790-2326
Mailing Address - Fax:586-790-2476
Practice Address - Street 1:18791 FIFTEEN MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2503
Practice Address - Country:US
Practice Address - Phone:586-790-2326
Practice Address - Fax:586-790-2476
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist