Healthcare Provider Details

I. General information

NPI: 1194249870
Provider Name (Legal Business Name): KARA SNIDER PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA RAYMOND

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 WINN WAY STE 120
DECATUR GA
30030-1709
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 404-389-0077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013070
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: