Provider Demographics
NPI:1164960902
Name:AVERDICK, JONATHAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:AVERDICK
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 1:2200 CONNER RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-8142
Mailing Address - Country:US
Mailing Address - Phone:859-814-0022
Mailing Address - Fax:859-814-0024
Practice Address - Street 1:2200 CONNER RD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-8142
Practice Address - Country:US
Practice Address - Phone:859-814-0022
Practice Address - Fax:859-814-0024
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist