Provider Demographics
NPI:1508291253
Name:SHAMBLIN, CHRISTINE (LAT ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3916
Mailing Address - Country:US
Mailing Address - Phone:336-718-6747
Mailing Address - Fax:336-718-6798
Practice Address - Street 1:1903 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3916
Practice Address - Country:US
Practice Address - Phone:336-718-6747
Practice Address - Fax:336-718-6798
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer