MEDICARE: JONATHAN PAUL SLATER PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501014868	MI

General Provider Information

NPI Number	:	1184950248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN PAUL SLATER PT, DPT

Provider Business Mailing Address
First Line	:	5836 S 4TH ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-8435
Country	:	US
Telephone Number	:	269-744-0232
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 STADIUM DR
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-3022
Country	:	US
Telephone Number	:	269-372-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	12/11/2018

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