Provider Demographics
NPI:1619321155
Name:SNIDER, RANDAL (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:
Last Name:SNIDER
Suffix:
Gender:M
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 1:9810 STONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3253
Mailing Address - Country:US
Mailing Address - Phone:580-467-8180
Mailing Address - Fax:
Practice Address - Street 1:1400 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1499
Practice Address - Country:US
Practice Address - Phone:254-299-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9512255A2300X
TXAT94082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer