1134830649 NPI number — COURTNEY SNYDERMAN M.S., LBS, RBT

Table of content: COURTNEY SNYDERMAN M.S., LBS, RBT (NPI 1134830649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134830649 NPI number — COURTNEY SNYDERMAN M.S., LBS, RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDERMAN
Provider First Name:
COURTNEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., LBS, RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134830649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 WEST BALTIMORE PIKE
Provider Second Line Business Mailing Address:
SUITE 100 B
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-572-5520
Provider Business Mailing Address Fax Number:
610-572-5521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 WEST BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
SUITE 100 B
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-572-5520
Provider Business Practice Location Address Fax Number:
610-572-5521
Provider Enumeration Date:
12/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-21-196814 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: BH006276 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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