Healthcare Provider Details

I. General information

NPI: 1265586515
Provider Name (Legal Business Name): SUSAN TINKELENBERG SNYDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2372 EAGLE DR NE
CONOVER NC
28613-9497
US

IV. Provider business mailing address

2974 NINTH TEE DR
NEWTON NC
28658-8575
US

V. Phone/Fax

Practice location:
  • Phone: 828-459-9000
  • Fax: 828-459-7610
Mailing address:
  • Phone: 828-465-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number3806
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: