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NPI Code Detail

MEDICARE: JONATHAN DAVID EKHOFF LAT

MEDICARE:   JONATHAN DAVID EKHOFF  LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer59-039WI

General Provider Information

NPI Number : 1295792786
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN DAVID EKHOFF LAT
Provider Business Mailing Address
First Line : N4483 DUNNING RD
Second Line :
City : RIO
State : WI
Zip : 53960-9586
Country : US
Telephone Number : 715-892-7974
Fax Number :
Provider Business Practice Location Address
First Line : 5412 US HIGHWAY 10 E
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8559
Country : US
Telephone Number : 715-346-5243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 11/17/2022

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Directions to “ JONATHAN DAVID EKHOFF LAT” Practice Location

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