Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 99999 | WV |
NPI | 1003178633 |
---|---|
Provider Name | Jenna Snyder |
First Address | Fairmont, WV 26554-2135 |
Second Address | Fairmont, WV 26554-2135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2012 |
Last Update Date | 11/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810013762 | (05) | WV |