Provider Demographics
NPI:1508818428
Name:SNOW, SHANNON (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:SNOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3525 SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2208
Mailing Address - Country:US
Mailing Address - Phone:719-347-9309
Mailing Address - Fax:719-347-9311
Practice Address - Street 1:3525 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2208
Practice Address - Country:US
Practice Address - Phone:719-347-9309
Practice Address - Fax:719-347-9311
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 8825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804757Medicare PIN