Provider Demographics
NPI:1447320684
Name:HATHCOCK, JONATHAN PATRICK (PT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PATRICK
Last Name:HATHCOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:706 E SHORE LINE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-4249
Mailing Address - Country:US
Mailing Address - Phone:417-894-6393
Mailing Address - Fax:417-881-2918
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:STE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4247
Practice Address - Country:US
Practice Address - Phone:417-881-2900
Practice Address - Fax:417-881-2918
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist