Individual
SHANE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1241 VALLEY HILL TRL, SOUTHAMPTON, PA 18966-4613
(215) 512-7673
Mailing address
1241 VALLEY HILL TRL, SOUTHAMPTON, PA 18966-4613
(215) 512-7673
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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