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General NPI Number Information
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NPI Number | 1174904163
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Entity Type | Individual
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Provider Name | BENJAMIN SNYDER MA, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 840 6TH ST
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City | ANTHONY
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State | TX
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Zip | 79821-7124
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Country | US
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Telephone | 915-866-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 5890 BANDOLERO DR APT. 1076
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City | EL PASO
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State | TX
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Zip | 79912-6603
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Country | US
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Telephone | 402-419-6839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT6175
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License Number State | TX
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