Provider Demographics
NPI:1396780151
Name:SHIVERS, BETSY JOY (MA,ATC)
Entity type:Individual
Prefix:MISS
First Name:BETSY
Middle Name:JOY
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:MA,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-4709
Mailing Address - Country:US
Mailing Address - Phone:559-453-3688
Mailing Address - Fax:559-453-2005
Practice Address - Street 1:1717 S CHESTNUT AVE
Practice Address - Street 2:#2200
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-4709
Practice Address - Country:US
Practice Address - Phone:559-453-3688
Practice Address - Fax:559-453-2005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program