Provider Demographics
NPI:1225790975
Name:FOISY, SHANE CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:CHRISTOPHER
Last Name:FOISY
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 1:1001 GRAYSON DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2293
Mailing Address - Country:US
Mailing Address - Phone:215-964-7984
Mailing Address - Fax:
Practice Address - Street 1:1001 GRAYSON DR
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2293
Practice Address - Country:US
Practice Address - Phone:215-964-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG014268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty