Provider Demographics
NPI:1831406511
Name:SNOW, SHELLEY LEONE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LEONE
Last Name:SNOW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:L
Other - Last Name:COUTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2406 FIVE FORKS TRL
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1219
Mailing Address - Country:US
Mailing Address - Phone:410-404-0281
Mailing Address - Fax:
Practice Address - Street 1:2406 FIVE FORKS TRL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1219
Practice Address - Country:US
Practice Address - Phone:410-404-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002421225200000X
FLPTA32502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant