Healthcare Provider Details

I. General information

NPI: 1740308261
Provider Name (Legal Business Name): BONNIE J. SNYDER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SW COLORADO AVE STE. 125
BEND OR
97702-1150
US

IV. Provider business mailing address

15 SW COLORADO STE. 125
BEND OR
97702
US

V. Phone/Fax

Practice location:
  • Phone: 541-317-0464
  • Fax:
Mailing address:
  • Phone: 541-317-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: