Provider Demographics
NPI:1043305535
Name:SNYDER, LORI ROSE (LMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ROSE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 SW 81ST WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1617
Mailing Address - Country:US
Mailing Address - Phone:954-790-8077
Mailing Address - Fax:954-367-4570
Practice Address - Street 1:2741 SW 81ST WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1617
Practice Address - Country:US
Practice Address - Phone:954-790-8077
Practice Address - Fax:954-367-4570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44944174400000X
FLMM19079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist