Healthcare Provider Details

I. General information

NPI: 1598282311
Provider Name (Legal Business Name): JULIE ANNE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PAGE TER
STOUGHTON MA
02072-4602
US

IV. Provider business mailing address

76 ORCHARD ST
RANDOLPH MA
02368-3640
US

V. Phone/Fax

Practice location:
  • Phone: 774-219-9087
  • Fax:
Mailing address:
  • Phone: 774-219-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: