Healthcare Provider Details

I. General information

NPI: 1720299878
Provider Name (Legal Business Name): CAMILLE MONTAGUE SNYDER PT,DPT,OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMMY MONTAGUE

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 MAIN ST
KANSAS CITY MO
64111-1904
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 816-399-0806
  • Fax: 816-743-7413
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2020032454
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-02303
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: