Provider Demographics
NPI:1396611711
Name:IRON MITTEN PERFORMANCE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:IRON MITTEN PERFORMANCE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:517-879-6026
Mailing Address - Street 1:1818 AMBERINA DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-9730
Mailing Address - Country:US
Mailing Address - Phone:517-879-6026
Mailing Address - Fax:
Practice Address - Street 1:1818 AMBERINA DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-9730
Practice Address - Country:US
Practice Address - Phone:517-879-6026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty