Provider Demographics
NPI:1427013234
Name:SCHIELDS, KENNETH E (ATC/LAT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:E
Last Name:SCHIELDS
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 STIRLING FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4253
Mailing Address - Country:US
Mailing Address - Phone:941-351-7086
Mailing Address - Fax:
Practice Address - Street 1:8111 STIRLING FALLS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-4253
Practice Address - Country:US
Practice Address - Phone:941-351-7086
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer