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General NPI Number Information
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NPI Number | 1861502759
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Entity Type | Individual
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Provider Name | JON FRAVEL ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 206 FIELD HOUSE UNIVERSITY OF IOWA
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City | IOWA CITY
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State | IA
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Zip | 52242-1111
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Country | US
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Telephone | 319-335-9483
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Fax |
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Provider Business Mailing Address
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Address Line | 1028 NEWTON RD APT 8
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City | IOWA CITY
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State | IA
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Zip | 52246-2232
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Country | US
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Telephone | 712-490-3396
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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 | 00592
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License Number State | IA
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