Healthcare Provider Details

I. General information

NPI: 1063336782
Provider Name (Legal Business Name): SONORA SNOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
RICHMOND VA
23219-1930
US

IV. Provider business mailing address

582 PINE WATER WAY
HOLLAND MI
49424-6652
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305217747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: