Provider Demographics
NPI:1932729308
Name:SNYDER, BROOKE ALEXIS (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXIS
Last Name:SNYDER
Suffix:
Gender:F
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 1:1975 AQUARENA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8281
Mailing Address - Country:US
Mailing Address - Phone:302-650-0545
Mailing Address - Fax:
Practice Address - Street 1:4100 WESTBANK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6566
Practice Address - Country:US
Practice Address - Phone:928-051-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT80052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer