Provider Demographics
NPI:1629680822
Name:HITCHCOCK, JONATHAN EARL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EARL
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:
Practice Address - Street 1:2690 MADISON ST STE 120
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5984
Practice Address - Country:US
Practice Address - Phone:931-358-0559
Practice Address - Fax:931-358-0587
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1332260225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029723Medicaid