Jacob Cameron Shell

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501302669 Issued in MI

Practice address

4403 Betty Lee Blvd
Gladwin, MI 48624

Phone

(989) 329-8460

NPI assigned

Sep 3, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1558889162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 BETTY LEE BLVD",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "48624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 BETTY LEE BLVD",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "48624",
            "telephone_number": "989-329-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELL",
        "first_name": "JACOB",
        "middle_name": "CAMERON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-03",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501302669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert Peter Sawaya, D.C.
• Faith Schell
• Tiffany Schmidt
• Julie L Schultz, OT
• Seck and Seck DO
• Lauren Shell
• Dan Sheppard, BS, LBSW, QMRP, QMHP
• Katherine Sherman
• Allison Rae Shoaf
• Shopko Stores Operating Co LLC

• Physical Therapist in Gladwin, MI
• Providers in Gladwin, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.