Individual
MR. JONATHAN ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, ATC, LAT
Contact information
Practice address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 827-8052
Mailing address
PO BOX 468, DUBLIN, IN 47335-0468
(765) 730-1094
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001185A
IN
Other
Enumeration date
10/26/2009
Last updated
10/26/2009
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