Individual
JASON JOHN TERRY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, CSCS
Contact information
Practice address
1650 S 41ST ST, MANITOWOC, WI 54220-7316
(920) 320-3124
Mailing address
718 S 29TH ST, MANITOWOC, WI 54220-4302
(920) 860-1269
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
646-039
WI
Other
Enumeration date
04/10/2006
Last updated
07/08/2007
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