Basic Information
| Provider Information | |||||||||
| NPI: | 1982669370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNOW | ||||||||
| FirstName: | JODY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6121 N CANNON ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992056957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093277273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1414 N HOUK RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992161097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094735494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00003464 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.