Healthcare Provider Details

I. General information

NPI: 1255327995
Provider Name (Legal Business Name): ROBERT MARTIN SNYDER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 ALVORD PARK RD
TORRINGTON CT
06790-3493
US

IV. Provider business mailing address

14 HEARTHSTONE DR
BARKHAMSTED CT
06063-3368
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-9851
  • Fax:
Mailing address:
  • Phone: 860-738-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT. 002501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: