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General NPI Number Information
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NPI Number | 1083095103
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Entity Type | Individual
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Provider Name | JONATHAN GAGE BEABER ATC
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Gender | Male
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 7640 SYLVANIA AVE STE E
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City | SYLVANIA
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State | OH
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Zip | 43560-9263
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Country | US
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Telephone | 419-251-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 403 SUPERIOR ST
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City | GENOA
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State | OH
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Zip | 43430-1733
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Country | US
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Telephone | 419-307-7706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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