Provider Demographics
NPI:1083095103
Name:BEABER, JONATHAN GAGE (ATC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GAGE
Last Name:BEABER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:OH
Mailing Address - Zip Code:43430-1733
Mailing Address - Country:US
Mailing Address - Phone:419-307-7706
Mailing Address - Fax:
Practice Address - Street 1:5665 SEAMAN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-2613
Practice Address - Country:US
Practice Address - Phone:419-307-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer