Organization
SHANE FITNESS LLC
Active
Other names
Shane Fitness 101
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELAND MAURICE MCMULLAN JR. ATHLETIC TRAINER (ATHLETIC TRAINING)
(734) 320-4819
Entity
Organization
Contact information
Practice address
1122 WALNUT ST, YPSILANTI, MI 48198-3937
(734) 320-4819
Mailing address
1122 WALNUT ST, YPSILANTI, MI 48198-3937
(734) 320-4819
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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