Provider Demographics
NPI:1477796456
Name:SHEPHERD-PORADA, KOSIE L (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KOSIE
Middle Name:L
Last Name:SHEPHERD-PORADA
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2834
Mailing Address - Country:US
Mailing Address - Phone:814-255-6814
Mailing Address - Fax:814-255-7963
Practice Address - Street 1:927 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2834
Practice Address - Country:US
Practice Address - Phone:814-255-6814
Practice Address - Fax:814-255-7963
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0036942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer