Provider Demographics
NPI:1356637342
Name:DROUBAY, JONATHAN L (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:DROUBAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 S MEDICAL CENTER DR # LL10
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7017
Mailing Address - Country:US
Mailing Address - Phone:435-251-2250
Mailing Address - Fax:
Practice Address - Street 1:652 S MEDICAL CENTER DR # LL10
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7017
Practice Address - Country:US
Practice Address - Phone:435-251-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6989476-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist