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General NPI Number Information
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NPI Number | 1477796456
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Entity Type | Individual
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Provider Name | KOSIE L SHEPHERD-PORADA MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 927 MENOHER BLVD
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City | JOHNSTOWN
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State | PA
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Zip | 15905-2834
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Country | US
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Telephone | 814-255-6814
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Fax | 814-255-7963
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Provider Business Mailing Address
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Address Line | 927 MENOHER BLVD
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City | JOHNSTOWN
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State | PA
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Zip | 15905-2834
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Country | US
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Telephone | 814-255-6814
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Fax | 814-255-7963
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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 | RT003694
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License Number State | PA
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