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General NPI Number Information
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NPI Number | 1235915570
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Entity Type | Individual
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Provider Name | JONATHAN KOTREDES ATC
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Gender | Male
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 1500 S CAPITOL ST SE
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City | WASHINGTON
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State | DC
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Zip | 20003-3599
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Country | US
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Telephone | 202-302-9255
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Fax |
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Provider Business Mailing Address
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Address Line | 6393 BRANCHWOOD DR
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City | LAKE WORTH
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State | FL
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Zip | 33467-7378
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Country | US
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Telephone | 207-951-1702
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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 | AL4359
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License Number State | FL
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