Provider Demographics
NPI:1295142495
Name:SNIDER, KENNY (ATC)
Entity type:Individual
Prefix:MR
First Name:KENNY
Middle Name:
Last Name:SNIDER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 HORTONREST CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8730
Mailing Address - Country:US
Mailing Address - Phone:843-214-0323
Mailing Address - Fax:
Practice Address - Street 1:4827 HORTONREST CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8730
Practice Address - Country:US
Practice Address - Phone:843-214-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer