Healthcare Provider Details

I. General information

NPI: 1033453782
Provider Name (Legal Business Name): KIMBERLY CHRISTINA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78078 COUNTRY CLUB DR SUITE 205
BERMUDA DUNES CA
92203-8173
US

IV. Provider business mailing address

14 VINES RD
CHARLTON NY
12019-2707
US

V. Phone/Fax

Practice location:
  • Phone: 760-345-9934
  • Fax: 760-345-3086
Mailing address:
  • Phone: 518-487-1790
  • Fax: 760-345-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39520
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034418
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: