Provider Demographics
NPI:1619321155
Name:SNIDER, RANDAL (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:
Last Name:SNIDER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW 142ND ST.
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1586
Mailing Address - Country:US
Mailing Address - Phone:580-467-8180
Mailing Address - Fax:
Practice Address - Street 1:2501 N BLACKWELDER AVE
Practice Address - Street 2:FREEDE WELLNESS CENTER
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1402
Practice Address - Country:US
Practice Address - Phone:405-208-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60012255A2300X
OK9512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer