Healthcare Provider Details

I. General information

NPI: 1053717363
Provider Name (Legal Business Name): BRANDHEN SNYDER M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19510 VENTURA BLVD
TARZANA CA
91356-2969
US

IV. Provider business mailing address

19510 VENTURA BLVD
TARZANA CA
91356-2969
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1725
  • Fax: 818-996-0210
Mailing address:
  • Phone: 818-996-1725
  • Fax: 818-996-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: