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General NPI Number Information
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NPI Number | 1770509135
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Entity Type | Individual
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Provider Name | MARK ALAN SNOW ATC
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6001 DODGE ST HPER 100
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City | OMAHA
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State | NE
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Zip | 68182-0284
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Country | US
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Telephone | 402-554-3170
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Fax | 402-554-3697
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Provider Business Mailing Address
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Address Line | 6633 N 115TH ST
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City | OMAHA
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State | NE
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Zip | 68164-6870
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Country | US
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Telephone | 402-490-4793
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Fax | 402-554-3697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 184
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License Number State | NE
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