Provider Demographics
NPI:1154780146
Name:LOVERCAMP, JONATHON (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:
Last Name:LOVERCAMP
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 1:2600 ADAMS ST APT 8
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-7167
Mailing Address - Country:US
Mailing Address - Phone:417-682-1737
Mailing Address - Fax:
Practice Address - Street 1:245 NE 30 RD
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-9251
Practice Address - Country:US
Practice Address - Phone:620-786-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-010842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer