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General NPI Number Information
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NPI Number | 1619321155
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Entity Type | Individual
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Provider Name | RANDAL SNIDER ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1400 COLLEGE DR
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City | WACO
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State | TX
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Zip | 76708-1499
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Country | US
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Telephone | 254-299-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 9810 STONY POINT DR
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City | WACO
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State | TX
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Zip | 76712-3253
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Country | US
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Telephone | 580-467-8180
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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 | 951
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT9408
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License Number State | TX
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