Provider Demographics
NPI:1225034945
Name:MCNABB, JONATHAN BENNETT (MSPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BENNETT
Last Name:MCNABB
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 STONE BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-9721
Mailing Address - Country:US
Mailing Address - Phone:270-791-5972
Mailing Address - Fax:
Practice Address - Street 1:395 STONE BLUFF LN
Practice Address - Street 2:
Practice Address - City:ALVATON
Practice Address - State:KY
Practice Address - Zip Code:42122-9721
Practice Address - Country:US
Practice Address - Phone:270-791-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000532436OtherANTHEM
KYP00363023OtherRAILROAD MEDICARE
KY000000310071OtherANTHEM
7659534OtherAETNA
KY87001129Medicaid
7659534OtherAETNA
KY00394002Medicare PIN