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Individual

BETHANY ELLEN STORCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
117 STOKELY ATHLETIC CTR, KNOXVILLE, TN 37996-0001
(865) 974-6485
Mailing address
2100 WILSON RD, APARTMENT 431, KNOXVILLE, TN 37912-6033
(203) 417-6782

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1119
TN
2255A2300X
Athletic Trainer
327
NH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
060602170
BOC CERTIFICATION NUMBER
NH
Enumeration date
12/04/2006
Last updated
06/01/2008
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