| NPI | 1871108563 |
|---|---|
| Doing Business As | SHANE FITNESS 101 |
| Entity Type | Organization |
| Authorized Contact | DELAND MAURICE MCMULLAN Athletic Training 734-320-4819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-09-10 |