Provider Demographics
NPI:1487293718
Name:SNYDER, LORI RENAE (PTA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:RENAE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-0671
Mailing Address - Country:US
Mailing Address - Phone:308-631-4717
Mailing Address - Fax:
Practice Address - Street 1:1723 23RD ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:NE
Practice Address - Zip Code:69357-1000
Practice Address - Country:US
Practice Address - Phone:308-623-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE893225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant