Provider Demographics
NPI:1174752497
Name:SNOW, DOUGLAS CHARLES
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:SNOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 WEST COUNTY LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-886-5027
Practice Address - Street 1:1411 WEST COUNTY LINE RD, SUITE A
Practice Address - Street 2:HTS OUTPATIENT THERAPY SERVICES
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-886-5027
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99037476A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist