Provider Demographics
NPI:1346796752
Name:BROWN-SNYDER, JEANETTE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:BROWN-SNYDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 E STAPP CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-7076
Mailing Address - Country:US
Mailing Address - Phone:559-690-0769
Mailing Address - Fax:
Practice Address - Street 1:10121 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5745
Practice Address - Country:US
Practice Address - Phone:360-735-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist