MEDICARE: STACY SNOW DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305209932	VA

General Provider Information

NPI Number	:	1790142081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY SNOW DPT

Provider Business Mailing Address
First Line	:	3004 LEE HWY
Second Line	:	D-111
City	:	ARLINGTON
State	:	VA
Zip	:	22201-4233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 LEE HWY
Second Line	:	D-111
City	:	ARLINGTON
State	:	VA
Zip	:	22201-4233
Country	:	US
Telephone Number	:	703-671-6038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	01/18/2016

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