Provider Demographics
NPI:1003214743
Name:WEBB, JONATHAN (PEDORTHIST)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:WEBB
Suffix:
Gender:M
Credentials:PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-0879
Mailing Address - Country:US
Mailing Address - Phone:605-225-1141
Mailing Address - Fax:605-725-6904
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4318
Practice Address - Country:US
Practice Address - Phone:605-225-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist