Individual
JASON SHALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
50912 GRATIOT AVE, CHESTERFIELD, MI 48051-3134
(586) 200-6603
(586) 200-6604
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
(630) 928-5080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501010038
MI
Other
Enumeration date
10/01/2012
Last updated
04/06/2018
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