Individual
SHANNON CLEGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, ATC, CES, PES
Contact information
Practice address
1900 W OLNEY AVE, PHILADELPHIA, PA 19141-1108
(215) 951-1519
Mailing address
1900 W OLNEY AVE, PHILADELPHIA, PA 19141-1108
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT004086
PA
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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