Provider Demographics
NPI:1760450373
Name:BILLINGS, JONATHAN W (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:W
Last Name:BILLINGS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 N SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1531
Mailing Address - Country:US
Mailing Address - Phone:231-299-0334
Mailing Address - Fax:231-845-2137
Practice Address - Street 1:1 ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-299-0334
Practice Address - Fax:231-845-2137
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027807174400000X
MI55010096762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare ID - Type Unspecified