Provider Demographics
NPI:1891034534
Name:HOBAN, SHANNON MAUREEN (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MAUREEN
Last Name:HOBAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1317
Mailing Address - Country:US
Mailing Address - Phone:818-843-1919
Mailing Address - Fax:818-843-3587
Practice Address - Street 1:225 S GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1317
Practice Address - Country:US
Practice Address - Phone:818-843-1919
Practice Address - Fax:818-843-3587
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist