Provider Demographics
NPI:1831208628
Name:SNOW, JEFFREY HAROLD (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HAROLD
Last Name:SNOW
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 1:12055 PERSIMMON TER
Mailing Address - Street 2:STE. 130
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3808
Mailing Address - Country:US
Mailing Address - Phone:530-889-0478
Mailing Address - Fax:530-889-1046
Practice Address - Street 1:12055 PERSIMMON TER
Practice Address - Street 2:STE. 130
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3808
Practice Address - Country:US
Practice Address - Phone:530-889-0478
Practice Address - Fax:530-889-1046
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist