Provider Demographics
NPI:1689867731
Name:HERZNER, JONATHAN MARK (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARK
Last Name:HERZNER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3032
Mailing Address - Country:US
Mailing Address - Phone:520-349-1335
Mailing Address - Fax:520-232-5601
Practice Address - Street 1:421 N ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3032
Practice Address - Country:US
Practice Address - Phone:520-349-1335
Practice Address - Fax:520-232-5601
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer