Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1063826154 |
---|---|
Provider Name | Mr. Zachary Allen Snow |
First Address | Fayetteville, AR 72703-6398 |
Second Address | Fayetteville, AR 72703-6398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 08/06/2016 |