Provider Demographics
NPI:1093903569
Name:SNIDER, WILLIAM BRIAN (CP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRIAN
Last Name:SNIDER
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N CHRISMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9314
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:800-866-5950
Practice Address - Street 1:1760 GOLD STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1800
Practice Address - Country:US
Practice Address - Phone:530-229-0351
Practice Address - Fax:530-229-0366
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP002973224P00000X, 222Z00000X, 225500000X, 225000000X
224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter