Provider Demographics
NPI:1861502759
Name:FRAVEL, JON (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:FRAVEL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 NEWTON RD APT 8
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2232
Mailing Address - Country:US
Mailing Address - Phone:712-490-3396
Mailing Address - Fax:
Practice Address - Street 1:206 FIELD HOUSE
Practice Address - Street 2:UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1111
Practice Address - Country:US
Practice Address - Phone:319-335-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer