Provider Demographics
NPI:1538474366
Name:SNARR, GRANT (BILL) CANNON (PT)
Entity Type:Individual
Prefix:
First Name:GRANT (BILL)
Middle Name:CANNON
Last Name:SNARR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13413 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1838
Mailing Address - Country:US
Mailing Address - Phone:801-368-7976
Mailing Address - Fax:
Practice Address - Street 1:13413 GROVE DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1838
Practice Address - Country:US
Practice Address - Phone:801-368-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167735-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist