Provider Demographics
NPI:1578589768
Name:SNOW, TARAH BADGER (PT)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:BADGER
Last Name:SNOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:LEEANN
Other - Last Name:BADGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1710 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4900
Mailing Address - Country:US
Mailing Address - Phone:702-489-9217
Mailing Address - Fax:702-489-9134
Practice Address - Street 1:1710 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4900
Practice Address - Country:US
Practice Address - Phone:702-489-9217
Practice Address - Fax:702-489-9134
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist