Healthcare Provider Details

I. General information

NPI: 1265912471
Provider Name (Legal Business Name): LUKE ANDREW SNYDER PT, DPT, OCS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 E THOUSAND OAKS BLVD STE 150
WESTLAKE VILLAGE CA
91362-3837
US

IV. Provider business mailing address

4165 E THOUSAND OAKS BLVD STE 150
WESTLAKE VILLAGE CA
91362-3837
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-1200
  • Fax:
Mailing address:
  • Phone: 323-865-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: