Provider Demographics
NPI:1194768176
Name:KOSER, SHAWNDA L (MSPT)
Entity type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:L
Last Name:KOSER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:SHAWNDA
Other - Middle Name:
Other - Last Name:SMUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:3100 WILLOW STREET PIKE S
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9373
Practice Address - Country:US
Practice Address - Phone:717-464-9013
Practice Address - Fax:717-464-9018
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016013490001Medicaid