Individual
JASON MATTHEW MACCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
COLLEGE BACKBONE RD, PRINCESS ANNE, MD 21853
(410) 651-6510
Mailing address
1324 ASPEN DR, SALISBURY, MD 21804-2065
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A0001341
MD
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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