Provider Demographics
NPI:1447896501
Name:KE, JONATHAN DALE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DALE
Last Name:KE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 PEACHTREE INDUSTRIAL BLVD.
Mailing Address - Street 2:SUITE K
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:678-446-1835
Mailing Address - Fax:
Practice Address - Street 1:4505 PEACHTREE INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE K
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:678-446-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist