Provider Demographics
NPI:1588220107
Name:COHEN, JONATHAN M (ED D, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:ED D, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1740
Mailing Address - Country:US
Mailing Address - Phone:650-714-9761
Mailing Address - Fax:
Practice Address - Street 1:1760 DOWN RIVER DR
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9699
Practice Address - Country:US
Practice Address - Phone:360-624-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9422482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer