Provider Demographics
NPI:1033608252
Name:VEAL, JOHNATHAN T
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:T
Last Name:VEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 W BUTLER DR APT 230
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5551
Mailing Address - Country:US
Mailing Address - Phone:623-340-6497
Mailing Address - Fax:
Practice Address - Street 1:6767 W BUTLER DR APT 230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5551
Practice Address - Country:US
Practice Address - Phone:623-340-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care