Provider Demographics
NPI:1578952891
Name:SPOERNDLE, JONAH MATTHEW
Entity Type:Individual
Prefix:MR
First Name:JONAH
Middle Name:MATTHEW
Last Name:SPOERNDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 PORTAGE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1431
Mailing Address - Country:US
Mailing Address - Phone:330-573-7457
Mailing Address - Fax:
Practice Address - Street 1:1135 PORTAGE LAKES DR
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-1431
Practice Address - Country:US
Practice Address - Phone:330-573-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program