MEDICARE: TRAVIS DAVID SNYDER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT.002684	OH
2	225200000X	Physical Therapy Assistant	A4433	MD
3	2255A2300X	Athletic Trainer	A0000795	MD

General Provider Information

NPI Number	:	1538398805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS DAVID SNYDER ATC

Provider Business Mailing Address
First Line	:	6109 SILVER ARROWS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7411
Country	:	US
Telephone Number	:	812-454-3664
Fax Number	:

Provider Business Practice Location Address
First Line	:	6109 SILVER ARROWS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7411
Country	:	US
Telephone Number	:	812-454-3664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	08/23/2016

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