Healthcare Provider Details

I. General information

NPI: 1912382425
Provider Name (Legal Business Name): KYLE DOUGLAS HOSIER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2015
Last Update Date: 07/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S SHAFER ST APT 2006
ATHENS OH
45701-2795
US

IV. Provider business mailing address

15 S SHAFER ST APT 2006
ATHENS OH
45701-2795
US

V. Phone/Fax

Practice location:
  • Phone: 716-640-1593
  • Fax:
Mailing address:
  • Phone: 716-640-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001408
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: