Provider Demographics
NPI:1619198264
Name:HOSIE, SHANNON LISE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LISE
Last Name:HOSIE
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 HOOK HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4903
Mailing Address - Country:US
Mailing Address - Phone:631-806-2467
Mailing Address - Fax:
Practice Address - Street 1:4952 HOOK HOLLOW CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4903
Practice Address - Country:US
Practice Address - Phone:631-806-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL308392251P0200X
NY0210882251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics