Provider Demographics
NPI:1912382425
Name:HOSIER, KYLE DOUGLAS (ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DOUGLAS
Last Name:HOSIER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S SHAFER ST
Mailing Address - Street 2:APT 2006
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2795
Mailing Address - Country:US
Mailing Address - Phone:716-640-1593
Mailing Address - Fax:
Practice Address - Street 1:15 S SHAFER ST
Practice Address - Street 2:APT 2006
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2795
Practice Address - Country:US
Practice Address - Phone:716-640-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-26
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0014082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer