Provider Demographics
NPI:1306063904
Name:OSBORNE, SHAY D (PT)
Entity type:Individual
Prefix:MRS
First Name:SHAY
Middle Name:D
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHAY
Other - Middle Name:DANIELLE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:619 E. CALTON RD.
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-722-3377
Mailing Address - Fax:956-722-3892
Practice Address - Street 1:619 E. CALTON RD.
Practice Address - Street 2:SUITE # 3
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-722-3377
Practice Address - Fax:956-722-3892
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3126225100000X
TX1205238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280737201Medicaid