Provider Demographics
NPI:1205396694
Name:JANIK, JONATHAN M (ATC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:JANIK
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 1:16819 S DUPONT HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-3192
Mailing Address - Country:US
Mailing Address - Phone:302-786-3008
Mailing Address - Fax:
Practice Address - Street 1:5407 KILLENS POND RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943-1901
Practice Address - Country:US
Practice Address - Phone:302-284-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00004292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer