Individual
JACOB CAMERON SHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4403 BETTY LEE BLVD, GLADWIN, MI 48624
(989) 329-8460
Mailing address
4403 BETTY LEE BLVD, GLADWIN, MI 48624
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501302669
MI
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/03/2017
Last updated
10/16/2023
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