=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013128461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN REIKO HOSHI PT, MSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 SAM PERRY BLVD
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22401-4490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 549-741-1545
-----------------------------------------------------
Fax | 540-741-1543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 CHARLESTON CT
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-659-6736
-----------------------------------------------------
Fax | 540-741-1543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 6883
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 4250
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------