Provider Demographics
NPI:1427022128
Name:SNOW, CALISTA E (PT)
Entity Type:Individual
Prefix:
First Name:CALISTA
Middle Name:E
Last Name:SNOW
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 1:22 SOUTHPARK SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-3307
Mailing Address - Country:US
Mailing Address - Phone:870-845-5600
Mailing Address - Fax:870-845-5605
Practice Address - Street 1:22 SOUTHPARK SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3307
Practice Address - Country:US
Practice Address - Phone:870-845-5600
Practice Address - Fax:870-845-5605
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142483721Medicaid
AR142483721Medicaid