Provider Demographics
NPI:1174915029
Name:SHROYER, JOSHUA (ATC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SHROYER
Suffix:
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 1:3000 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-1737
Mailing Address - Country:US
Mailing Address - Phone:276-326-4349
Mailing Address - Fax:276-326-4484
Practice Address - Street 1:3000 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-1737
Practice Address - Country:US
Practice Address - Phone:276-326-4349
Practice Address - Fax:276-326-4484
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer