Provider Demographics
NPI:1679833461
Name:SNOOZY, MEGAN A (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:SNOOZY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1533
Mailing Address - Country:US
Mailing Address - Phone:712-234-8760
Mailing Address - Fax:712-234-8735
Practice Address - Street 1:915 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1031
Practice Address - Country:US
Practice Address - Phone:712-234-8760
Practice Address - Fax:712-234-8765
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA005001OtherLICENSE
IAP01093299OtherRR MEDICARE
IAI10240002Medicare UPIN
IAI10240002Medicare PIN