Individual
KENNETH SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1350 KING COLLEGE RD, BRISTOL, TN 37620-2632
(800) 362-0014
Mailing address
362 GRANDVIEW ST, CHURCH HILL, TN 37642-3828
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2994
TN
Other
Enumeration date
09/19/2022
Last updated
09/19/2022
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