Provider Demographics
NPI:1770509135
Name:SNOW, MARK ALAN (ATC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:SNOW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:6633 N 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6870
Mailing Address - Country:US
Mailing Address - Phone:402-490-4793
Mailing Address - Fax:402-554-3697
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:HPER 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-0284
Practice Address - Country:US
Practice Address - Phone:402-554-3170
Practice Address - Fax:402-554-3697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer