Healthcare Provider Details

I. General information

NPI: 1487837662
Provider Name (Legal Business Name): MRS. EMILY SNODGRASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

IV. Provider business mailing address

5790 SCENIC HILLS DR
ROANOKE VA
24018-5210
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: