Healthcare Provider Details

I. General information

NPI: 1538474366
Provider Name (Legal Business Name): GRANT (BILL) CANNON SNARR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13413 GROVE DR
ALPINE UT
84004-1838
US

IV. Provider business mailing address

13413 GROVE DR
ALPINE UT
84004-1838
US

V. Phone/Fax

Practice location:
  • Phone: 801-368-7976
  • Fax:
Mailing address:
  • Phone: 801-368-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number167735-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: