Healthcare Provider Details

I. General information

NPI: 1871859942
Provider Name (Legal Business Name): BRIAN KENNETH SNITILY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROADWAY FL 6
SEATTLE WA
98122-5330
US

IV. Provider business mailing address

805 MADISON ST STE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2600
  • Fax: 206-622-1644
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD90488995
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60488992
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: