Healthcare Provider Details

I. General information

NPI: 1003307984
Provider Name (Legal Business Name): BECKY LEE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ENTERPRISE AVE NE
ISANTI MN
55040-6813
US

IV. Provider business mailing address

4 ENTERPRISE AVE NE
ISANTI MN
55040-6813
US

V. Phone/Fax

Practice location:
  • Phone: 763-552-6161
  • Fax: 763-237-3254
Mailing address:
  • Phone: 763-552-6161
  • Fax: 763-237-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: