Provider Demographics
NPI:1174904163
Name:SNYDER, BENJAMIN (MA, ATC, LAT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 BANDOLERO DR
Mailing Address - Street 2:APT. 1076
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6603
Mailing Address - Country:US
Mailing Address - Phone:402-419-6839
Mailing Address - Fax:
Practice Address - Street 1:840 6TH ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821-7124
Practice Address - Country:US
Practice Address - Phone:915-866-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT61752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer