Provider Demographics
NPI:1043275860
Name:CARTER, JONATHAN ANDREW (ATC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:CARTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 WESTGATE CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2093
Mailing Address - Country:US
Mailing Address - Phone:757-258-2492
Mailing Address - Fax:757-221-3412
Practice Address - Street 1:WILLIAM AND MARY HALL
Practice Address - Street 2:1 CAMPUS DRIVE
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23186-0001
Practice Address - Country:US
Practice Address - Phone:757-221-2790
Practice Address - Fax:757-221-3412
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer