Provider Demographics
NPI:1548385545
Name:SNOW, VALLERIE ANN IV (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:VALLERIE
Middle Name:ANN
Last Name:SNOW
Suffix:IV
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 77
Mailing Address - Street 2:
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-9402
Mailing Address - Country:US
Mailing Address - Phone:304-884-7385
Mailing Address - Fax:
Practice Address - Street 1:6298 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378
Practice Address - Country:US
Practice Address - Phone:304-884-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2006-2266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2006-2266OtherWV MASSAGE THERAPY LIC.