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General NPI Number Information
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NPI Number | 1124243068
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Entity Type | Individual
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Provider Name | MS. CHARLENE R. SHANK
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 HIGH ST
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City | MANCHESTER
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State | PA
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Zip | 17345-1508
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Country | US
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Telephone | 717-266-3644
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Fax | 717-266-0616
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Provider Business Mailing Address
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Address Line | 2505 BREMER RD
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City | DOVER
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State | PA
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Zip | 17315-2051
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Country | US
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Telephone | 717-292-5932
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Fax | 717-266-0616
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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 | RT001469A
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License Number State | PA
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