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General NPI Number Information
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NPI Number | 1356510473
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Entity Type | Organization
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Legal Business Name | LISLE SNYDER, DPM
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 207 W G ST
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City | ELIZABETHTON
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State | TN
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Zip | 37643-3113
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Country | US
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Telephone | 423-543-8719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 812
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City | ELIZABETHTON
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State | TN
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Zip | 37644-0812
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Country | US
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Telephone | 423-543-8719
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISLE SNYDER
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Credential |
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Telephone | 423-543-8719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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