Provider Demographics
NPI:1700013729
Name:PLUSH, JONATHAN G (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:G
Last Name:PLUSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4573
Mailing Address - Country:US
Mailing Address - Phone:614-775-9618
Mailing Address - Fax:614-775-9633
Practice Address - Street 1:1914 TAMARACK ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:740-788-8100
Practice Address - Fax:740-788-8240
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1740360262OtherCLINIC NPI
OH0801341Medicaid
OH1740360262OtherCLINIC NPI