Individual
JASON LOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 565-3055
Mailing address
110 LIBERTY ST STE 505, BROCKTON, MA 02301-5674
(508) 565-3055
(508) 894-0757
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
291672
MA
208D00000X
General Practice Physician
036.150868
IL
Other
Enumeration date
06/23/2016
Last updated
06/07/2022
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