Healthcare Provider Details

I. General information

NPI: 1962511840
Provider Name (Legal Business Name): JONATHAN TODD GARDNER CHES, PTA, EXP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 W DICKMAN RD SUITE L
SPRINGFIELD MI
49015-4895
US

IV. Provider business mailing address

1621 ROSELAND AVE
KALAMAZOO MI
49001-4353
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1101
  • Fax: 269-966-1113
Mailing address:
  • Phone: 269-966-1101
  • Fax: 269-966-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: