Provider Demographics
NPI:1447495171
Name:SNYDER, RENEE CARLSON (PT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:CARLSON
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:19 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-733-5253
Mailing Address - Fax:
Practice Address - Street 1:19 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6426
Practice Address - Country:US
Practice Address - Phone:315-733-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015404-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics