Provider Demographics
NPI:1639131428
Name:PRICE, JON MATTHEW (ATC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:MATTHEW
Last Name:PRICE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 WILLOWGLEN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4639
Mailing Address - Country:US
Mailing Address - Phone:409-550-1503
Mailing Address - Fax:409-880-8328
Practice Address - Street 1:4400 MARTIN LUTHER KING BLVD
Practice Address - Street 2:ATHLETIC TRAINING
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-880-8328
Practice Address - Fax:409-880-2366
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT32782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer