Basic Information
| Provider Information | |||||||||
| NPI: | 1508224544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177573537 | ||||||||
| FaxNumber: | 7177189701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1038 LITITZ PIKE | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175439328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177573537 | ||||||||
| FaxNumber: | 7177189701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT024969 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 003379600 | 01 | PA | HIGHMARK BLUE CROSS BLUE SHIELD | OTHER | 1030947290001 | 05 | PA | MEDICAID | 50140163 | 01 | PA | CAPITAL BLUE CROSS | OTHER |