Provider Demographics
NPI:1952872046
Name:HOSFORD, RAEANN G (LPTA)
Entity type:Individual
Prefix:MISS
First Name:RAEANN
Middle Name:G
Last Name:HOSFORD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14565 ABBEY LN APT A7
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808-7714
Mailing Address - Country:US
Mailing Address - Phone:517-896-4456
Mailing Address - Fax:
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3495
Practice Address - Country:US
Practice Address - Phone:517-975-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008925225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant