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General NPI Number Information
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NPI Number | 1619644465
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Entity Type | Individual
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Provider Name | JONATHAN MENDRES LAT,ATC
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Gender | Male
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 5355 SCHOOL RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4322
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Country | US
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Telephone | 727-774-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 13815 CADEN GLEN DR
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City | HUDSON
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State | FL
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Zip | 34669-5021
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Country | US
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Telephone |
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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 | AL4573
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License Number State | FL
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