Provider Demographics
NPI:1508871963
Name:HAUSER, SHANNON E (PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:HAUSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 36TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6587
Mailing Address - Country:US
Mailing Address - Phone:772-794-1234
Mailing Address - Fax:772-794-7890
Practice Address - Street 1:1285 36TH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6587
Practice Address - Country:US
Practice Address - Phone:772-794-1234
Practice Address - Fax:772-794-7890
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT00018370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8173OtherBCBS
FLK1110OtherMEDICARE GROUP
FLY8173OtherBCBS
FLK1110OtherMEDICARE GROUP