Individual
JONATHAN EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
101 BROAD ST, PLATTSBURGH, NY 12901-2637
(518) 578-4158
Mailing address
39 MONTY ST, PLATTSBURGH, NY 12901-3702
(518) 578-4158
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/30/2020
Last updated
11/20/2020
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