Provider Demographics
NPI:1083179170
Name:SNYDER, KELLI S (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:S
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 AMERICAN WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6117
Mailing Address - Country:US
Mailing Address - Phone:318-841-0696
Mailing Address - Fax:
Practice Address - Street 1:727 AMERICAN WAY STE 2
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6117
Practice Address - Country:US
Practice Address - Phone:318-841-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist