Provider Demographics
NPI:1013315712
Name:EICHNER, JONATHON OLIVER (DPT)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:OLIVER
Last Name:EICHNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2151
Mailing Address - Country:US
Mailing Address - Phone:480-489-5732
Mailing Address - Fax:801-492-6579
Practice Address - Street 1:10133 N 92ND ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4556
Practice Address - Country:US
Practice Address - Phone:480-681-5119
Practice Address - Fax:480-681-5120
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13320225100000X, 261QP2000X
UT9058233-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty