Healthcare Provider Details

I. General information

NPI: 1265957864
Provider Name (Legal Business Name): SHELBY PAIGE SHERMAN LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N WASHINGTON ST
GETTYSBURG PA
17325-1483
US

IV. Provider business mailing address

300 N WASHINGTON ST
GETTYSBURG PA
17325-1483
US

V. Phone/Fax

Practice location:
  • Phone: 717-337-6479
  • Fax:
Mailing address:
  • Phone: 717-337-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT007844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: