Healthcare Provider Details

I. General information

NPI: 1013315712
Provider Name (Legal Business Name): JONATHON OLIVER EICHNER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 N 92ND ST STE 102
SCOTTSDALE AZ
85258-4556
US

IV. Provider business mailing address

636 E STATE RD
AMERICAN FORK UT
84003-2151
US

V. Phone/Fax

Practice location:
  • Phone: 480-681-5119
  • Fax: 480-681-5120
Mailing address:
  • Phone: 480-489-5732
  • Fax: 801-492-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number13320
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13320
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9058233-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: