Provider Demographics
NPI:1619025830
Name:SNELL, BRUCE J (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:SNELL
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 1:4411 POINT FOSDICK DR NW STE 101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1703
Mailing Address - Country:US
Mailing Address - Phone:253-851-7472
Mailing Address - Fax:253-851-7473
Practice Address - Street 1:4411 POINT FOSDICK DR NW STE 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1703
Practice Address - Country:US
Practice Address - Phone:253-851-7472
Practice Address - Fax:253-851-7473
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8374456Medicaid
WA121269OtherL&I
WA7472SNOtherREGENCE GH
WASN5136OtherREGENCE TACOMA
WA650006358OtherRR MC
WASN5136OtherREGENCE TACOMA