Individual
JASON GROTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
107 WELLS ST, PANA, IL 62557-1361
(217) 565-9530
Mailing address
107 WELLS ST, PANA, IL 62557-1361
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2017
Last updated
07/30/2019
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