Healthcare Provider Details

I. General information

NPI: 1194648220
Provider Name (Legal Business Name): JONATHAN FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 SEAPORT DR
CHESTER PA
19013
US

IV. Provider business mailing address

8013 CHESTERTON DR
WOODRIDGE IL
60517-8009
US

V. Phone/Fax

Practice location:
  • Phone: 630-407-7203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000059309
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: