Provider Demographics
NPI:1275950081
Name:SNOWDEN, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SNOWDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8130
Mailing Address - Country:US
Mailing Address - Phone:386-898-0443
Mailing Address - Fax:386-898-0459
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B-2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-898-0443
Practice Address - Fax:386-898-0459
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24238225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant