SHANE FITNESS LLC (NPI# 1871108563) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871108563 |
| Entity Type | Organization |
| Organization Name | SHANE FITNESS LLC |
| Practice Address |
1122 Walnut St Ypsilanti MI 48198-3937 |
| Practice Telephone | 7343204819 |
| Mailing Telephone | 7343204819 |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-09-10 |
| Authorized Official Name | MR. DELAND MAURICE MCMULLAN JR. (ATHLETIC TRAINING) |
| Authorized Official Telephone | 7343204819 |
| Authorized Official Credential | ATHLETIC TRAINER |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Other Name | Type Code |
|---|---|
| Shane Fitness 101 | Doing Business As Name - Organization |
| Street Address |
1122 WALNUT ST |
| City | YPSILANTI |
| State | MI |
| Zip Code | 48198-3937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295345056 | Deland Maurice Mcmullan Jr. | Specialist/Technologist | 1122 Walnut St, Ypsilanti, MI 48198-3937 | 2020-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740840602 | Paxxon Healthcare Services LLC | Occupational Therapist | 8100 Geddes Road, Superior Township, MI 48198 | 2019-06-13 |
| 1053885137 | Justine Altman | Health Educator | 9855 High Meadow Dr., Ypsilanti, MI 48198 | 2019-01-11 |
| 1730650516 | Mark Neumann | Driver | 1233 Hull Ave, Ypsilanti, MI 48198 | 2018-12-05 |
| 1144703810 | Douglas John Pealer | Speech-Language Pathologist | 8100 Geddes Rd, Superior Charter Township, MI 48198 | 2018-09-10 |
| 1225520919 | Kathleen M Hartwell-king Iv | Nurse Practitioner | 315 Holmes Rd, Ypsilanti, MI 48198 | 2018-05-30 |
| 1205354339 | Kawana Young | Home Health | 1811 George Ave, Ypsilanti, MI 48198 | 2017-09-09 |
| 1477009173 | Brittney Thomas | Technician, Other | 1431 Leforge Rd Apt 301, Ypsilant, MI 48198 | 2016-09-01 |
| 1528461167 | Emily Purdey | Social Worker | 8604 Pine Ct, Ypsilanti, MI 48198 | 2014-09-26 |
| 1063812550 | Harry Lee Hampton Jr. | Driver | 868 Allen St, Ypsilanti, MI 48198 | 2014-09-03 |
| 1073932760 | Ed Mcswain | Counselor | 6633 Stoney Creek Rd, Ypsilanti, MI 48198 | 2014-04-10 |
| Find all providers in zip 48198 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295345056 | Deland Maurice Mcmullan Jr. | Specialist/Technologist | 1122 Walnut St, Ypsilanti, MI 48198-3937 | 2020-08-06 |
| 1225692494 | Courtney Lynn Ziemba | Specialist/Technologist | 4554 Sycamore Dr, Ypsilanti, MI 48197-6125 | 2019-04-23 |
| 1538638671 | Krista Barnes | Specialist/Technologist | 2156 Lakeview Dr Apt 260, Ypsilanti, MI 48198-6738 | 2018-11-19 |
| 1750827457 | Danielle Darroch | Specialist/Technologist | 4926 Lakeridge St Apt Tb, Ypsilanti, MI 48197-1424 | 2017-01-18 |
| 1326599556 | Jodi Schumacher | Specialist/Technologist | 318j John W Porter Bldg, Eastern Michigan University, Ypsilanti, MI 48197 | 2016-10-24 |
| 1871946145 | Jejuan Quintel French | Specialist/Technologist | 18 Fairhills Dr, Ypsilanti, MI 48197-7416 | 2016-07-21 |
| 1689030033 | Aaron Struminger | Specialist/Technologist | Eastern Michigan University, 318u Porter Building, Ypsilanti, MI 48197 | 2016-01-14 |
| 1467582171 | Anthony John Whiren | Specialist/Technologist | 7200 Maplelawn Dr., Ypsilanti, MI 48197 | 2007-03-06 |
| 1891822375 | Stephen James Nordwall | Specialist/Technologist | 799 N. Hewitt Road, Convocation Center - Athletic Department, Ypsilanti, MI 48197 | 2007-02-28 |
| 1043368152 | Kara Lee Menzel | Specialist/Technologist | 6239 Hickory Ridge Ct, Ypsilanti, MI 48197-9489 | 2007-01-08 |
| Find all providers in YPSILANTI | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.