Provider Demographics
NPI:1376177832
Name:HONER, SHANNON (PTA24000)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HONER
Suffix:
Gender:F
Credentials:PTA24000
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HONER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA24000
Mailing Address - Street 1:2025 DIXIE BELLE DR APT M
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5378
Mailing Address - Country:US
Mailing Address - Phone:386-623-5494
Mailing Address - Fax:
Practice Address - Street 1:1000 W BROADWAY ST STE 214
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9262
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PTA24000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant