Healthcare Provider Details

I. General information

NPI: 1902001530
Provider Name (Legal Business Name): LESLIE A SNYDER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHURCH ST
MILLERSBURG PA
17061-1113
US

IV. Provider business mailing address

6255 STATE ROUTE 209
LYKENS PA
17048-8431
US

V. Phone/Fax

Practice location:
  • Phone: 717-692-0251
  • Fax:
Mailing address:
  • Phone: 717-453-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: