Provider Demographics
NPI:1073168977
Name:STROTHER, JONATHAN CALEB
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CALEB
Last Name:STROTHER
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:PO BOX 6668
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-5119
Mailing Address - Country:US
Mailing Address - Phone:252-245-1830
Mailing Address - Fax:828-689-1313
Practice Address - Street 1:100 ATHLETIC ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-9134
Practice Address - Country:US
Practice Address - Phone:252-245-1830
Practice Address - Fax:828-689-1313
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer