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General NPI Number Information
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NPI Number | 1134481005
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Entity Type | Organization
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Legal Business Name | ADVANCED WELLNESS & SPORTS REHAB, LLC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 14028 5TH ST
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City | DADE CITY
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State | FL
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Zip | 33525
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Country | US
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Telephone | 352-600-2232
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Fax | 352-292-0136
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Provider Business Mailing Address
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Address Line | 14028 5TH ST
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City | DADE CITY
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State | FL
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Zip | 33525-4311
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Country | US
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Telephone | 352-600-2232
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Fax | 352-292-0136
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP A SNYDER
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Credential | DC
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Telephone | 724-875-2460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH10458
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License Number State | FL
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