Provider Demographics
NPI:1356729206
Name:SNIDER, MICHAEL (ATS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SNIDER
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 LITTLE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7901
Mailing Address - Country:US
Mailing Address - Phone:920-639-4131
Mailing Address - Fax:
Practice Address - Street 1:1899 LITTLE VALLEY CT
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7901
Practice Address - Country:US
Practice Address - Phone:920-639-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer