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General NPI Number Information
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NPI Number | 1366500472
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Entity Type | Individual
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Provider Name | BETHANY ELLEN STORCK ATC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/01/2008
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Provider Practice Location Address
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Address Line | 117 STOKELY ATHLETIC CTR
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City | KNOXVILLE
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State | TN
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Zip | 37996-0001
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Country | US
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Telephone | 865-974-6485
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 WILSON RD APARTMENT 431
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City | KNOXVILLE
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State | TN
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Zip | 37912-6033
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Country | US
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Telephone | 203-417-6782
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Fax |
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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 | 327
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1119
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License Number State | TN
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