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General NPI Number Information
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NPI Number | 1063524759
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Entity Type | Individual
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Provider Name | SHELIA D CROCKETT ATC/L
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1350 KING COLLEGE RD
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City | BRISTOL
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State | TN
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Zip | 37620-2632
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Country | US
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Telephone | 423-652-4762
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Fax | 423-652-6041
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Provider Business Mailing Address
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Address Line | 1777 WENDOVER RD
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City | BRISTOL
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State | VA
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Zip | 24201-2842
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Country | US
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Telephone | 276-591-3799
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Fax | 423-652-6041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0000000651
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License Number State | TN
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