Healthcare Provider Details

I. General information

NPI: 1518936301
Provider Name (Legal Business Name): JARETT MICHAEL MASON ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N SHEFFIELD AVE DEPAUL UNIVERSITY
CHICAGO IL
60614-3290
US

IV. Provider business mailing address

2323 N SHEFFIELD AVE DEPAUL UNIVERSITY
CHICAGO IL
60614-3290
US

V. Phone/Fax

Practice location:
  • Phone: 773-325-4894
  • Fax: 773-325-7531
Mailing address:
  • Phone: 773-325-4894
  • Fax: 773-325-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: