Provider Demographics
NPI:1518936301
Name:MASON, JARETT MICHAEL (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JARETT
Middle Name:MICHAEL
Last Name:MASON
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2323 N SHEFFIELD AVE
Mailing Address - Street 2:DEPAUL UNIVERSITY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3290
Mailing Address - Country:US
Mailing Address - Phone:773-325-4894
Mailing Address - Fax:773-325-7531
Practice Address - Street 1:2323 N SHEFFIELD AVE
Practice Address - Street 2:DEPAUL UNIVERSITY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3290
Practice Address - Country:US
Practice Address - Phone:773-325-4894
Practice Address - Fax:773-325-7531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer