Provider Demographics
NPI:1821121849
Name:ISHOP, JON R (MED, ATC, LAT, PES,)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:R
Last Name:ISHOP
Suffix:
Gender:M
Credentials:MED, ATC, LAT, PES,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHAMPIONSHIP DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1753
Mailing Address - Country:US
Mailing Address - Phone:281-841-3779
Mailing Address - Fax:
Practice Address - Street 1:6 CHAMPIONSHIP DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1753
Practice Address - Country:US
Practice Address - Phone:281-841-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT21492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer