Individual
PAULA SHIVOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT ATC
Contact information
Practice address
440 N 5TH ST, STROUDSBURG, PA 18360-2439
(570) 878-9818
Mailing address
652 S MEDICAL CENTER DR STE 120, ST GEORGE, UT 84790-7077
(570) 878-9818
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
12014120-4810
UT
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12014120-4810
LICENSED ATHLETIC TRAINER
UT
01
—
2000026336
ATHLETIC TRAINER CERTIFIED BOC
—
Enumeration date
09/23/2015
Last updated
02/24/2022
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