MEDICARE: JONATHAN BENNETT MCNABB MSPT

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	004115	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00363023	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000532436	OTHER	KY	ANTHEM
3	000000310071	OTHER	KY	ANTHEM
4	7659534	OTHER		AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225034945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN BENNETT MCNABB MSPT

Provider Business Mailing Address
First Line	:	395 STONE BLUFF LN
Second Line	:
City	:	ALVATON
State	:	KY
Zip	:	42122-9721
Country	:	US
Telephone Number	:	270-791-5972
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 STONE BLUFF LN
Second Line	:
City	:	ALVATON
State	:	KY
Zip	:	42122-9721
Country	:	US
Telephone Number	:	270-791-5972
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/17/2023

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