Healthcare Provider Details

I. General information

NPI: 1093076507
Provider Name (Legal Business Name): WHITNEY M. SNYDER AT, ATC, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 CLARK AVE
ALLIANCE OH
44601-3929
US

IV. Provider business mailing address

1972 CLARK AVE
ALLIANCE OH
44601-3929
US

V. Phone/Fax

Practice location:
  • Phone: 330-829-6809
  • Fax:
Mailing address:
  • Phone: 330-829-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: