Provider Demographics
NPI:1356413207
Name:HOSKINSON, BRAD DEAN (PT)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:DEAN
Last Name:HOSKINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15688 US HIGHWAY 160 STE A
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-8104
Mailing Address - Country:US
Mailing Address - Phone:417-546-6030
Mailing Address - Fax:417-546-6029
Practice Address - Street 1:15688 US HIGHWAY 160 STE A
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MO
Practice Address - Zip Code:65653-8104
Practice Address - Country:US
Practice Address - Phone:417-546-6030
Practice Address - Fax:417-546-6029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO121146OtherBLUE CROSS BLUE SHIELD