Provider Demographics
NPI:1568490043
Name:SHRINER, ROBERT J JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:SHRINER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2716
Mailing Address - Country:US
Mailing Address - Phone:574-254-7320
Mailing Address - Fax:574-254-7482
Practice Address - Street 1:1202 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2716
Practice Address - Country:US
Practice Address - Phone:574-254-7320
Practice Address - Fax:574-254-7482
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN360001422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer