Healthcare Provider Details

I. General information

NPI: 1518749043
Provider Name (Legal Business Name): JARED SNOWAERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIANA CT APT A
PADUCAH KY
42001-6767
US

IV. Provider business mailing address

130 PARKWAY DR
MAYFIELD KY
42066-1976
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008848
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: