MEDICARE: MR. BRICE SNYDER LAT, ATC, BCS-O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZX2200X	Orthopedic Assistant	15-1143
2	2255A2300X	Athletic Trainer	0126002005	VA

General Provider Information

NPI Number	:	1144627613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRICE SNYDER LAT, ATC, BCS-O

Provider Business Mailing Address
First Line	:	230 CLEARFIELD AVE STE 124
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1832
Country	:	US
Telephone Number	:	757-321-3300
Fax Number	:	757-321-3330

Provider Business Practice Location Address
First Line	:	230 CLEARFIELD AVE STE 124
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1832
Country	:	US
Telephone Number	:	757-321-3300
Fax Number	:	757-321-3330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2014
Last Update Date	:	07/28/2023

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