Provider Demographics
NPI:1881160406
Name:SNOBERGER, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SNOBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39743 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:MN
Mailing Address - Zip Code:56367-9558
Mailing Address - Country:US
Mailing Address - Phone:320-237-3121
Mailing Address - Fax:
Practice Address - Street 1:800 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1485
Practice Address - Country:US
Practice Address - Phone:320-237-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program