Provider Demographics
NPI:1003307984
Name:SNYDER, BECKY LEE
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LEE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ENTERPRISE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-6813
Mailing Address - Country:US
Mailing Address - Phone:763-552-6161
Mailing Address - Fax:763-237-3254
Practice Address - Street 1:4 ENTERPRISE AVE NE
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6813
Practice Address - Country:US
Practice Address - Phone:763-552-6161
Practice Address - Fax:763-237-3254
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist