Basic Information
| Provider Information | |||||||||
| NPI: | 1548235211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOAK | ||||||||
| FirstName: | SHAUNA | ||||||||
| MiddleName: | MEGHAN | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | CNOS, PC | ||||||||
| Address2: | 575 SIOUX POINT ROAD | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172615 | ||||||||
| FaxNumber: | 6052172915 | ||||||||
| Practice Location | |||||||||
| Address1: | CNOS, PC | ||||||||
| Address2: | 575 SIOUX POINT ROAD | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172615 | ||||||||
| FaxNumber: | 6052172915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1308 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5834900 | 05 | SD | MEDICAID |