MEDICARE: SHAWN WILLIAM EDGERLY MS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1003837691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN WILLIAM EDGERLY MS, ATC

Provider Business Mailing Address
First Line	:	3523 W PROVIDENCE AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-2160
Country	:	US
Telephone Number	:	509-869-8048
Fax Number	:

Provider Business Practice Location Address
First Line	:	9107 N COUNTRY HOMES BLVD STE 13
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2070
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/11/2025

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