Provider Demographics
NPI:1215944962
Name:HEGEMIER, JONATHAN P (PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:HEGEMIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43469-1237
Mailing Address - Country:US
Mailing Address - Phone:419-849-2900
Mailing Address - Fax:419-849-2901
Practice Address - Street 1:108 E MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469-1209
Practice Address - Country:US
Practice Address - Phone:419-849-2900
Practice Address - Fax:419-849-2901
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT05091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist