Provider Demographics
NPI:1043542806
Name:SHORE, HELEN DIANE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:DIANE
Last Name:SHORE
Suffix:
Gender:F
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 1:201 WHISPERING PINE DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9512
Mailing Address - Country:US
Mailing Address - Phone:903-279-2603
Mailing Address - Fax:
Practice Address - Street 1:201 SANDCRAB BLVD
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2424
Practice Address - Country:US
Practice Address - Phone:361-551-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT33802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer