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Individual
JOSHUA SHRIDE
Active
Individual
JOSHUA SHRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096003855
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096003855
IDPH
IL
01
—
2000017540
BOC
IL
Enumeration date
06/18/2021
Last updated
06/18/2021
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