Provider Demographics
NPI:1871607077
Name:SHIPLEY, JASON MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 BELLONA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2012
Mailing Address - Country:US
Mailing Address - Phone:410-337-8847
Mailing Address - Fax:410-769-8591
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2012
Practice Address - Country:US
Practice Address - Phone:410-337-8847
Practice Address - Fax:410-769-8591
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21920OtherPHYSICAL THERAPIST LICENS