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Individual

JOSHUA SHRIDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
2300 S 1ST ST, CHAMPAIGN, IL 61820-7661
(217) 383-9400
Mailing address
2300 S 1ST ST, CHAMPAIGN, IL 61820-7661
(217) 383-9400

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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