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General NPI Number Information
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NPI Number | 1700212537
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Entity Type | Individual
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Provider Name | JONATHAN DANIEL HANCOCK MS, LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 1427 THISTLEWOOD LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-4991
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Country | US
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Telephone | 719-229-8358
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 THISTLEWOOD LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-4991
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Country | US
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Telephone | 719-229-8358
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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 | AT2004
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License Number State | TX
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