Provider Demographics
NPI:1285281592
Name:ELCOCK, JONATHAN
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ELCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 LAFRANCE RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-4818
Mailing Address - Country:US
Mailing Address - Phone:802-490-3547
Mailing Address - Fax:
Practice Address - Street 1:82 LAFRANCE RD
Practice Address - Street 2:
Practice Address - City:WEARE
Practice Address - State:NH
Practice Address - Zip Code:03281-4818
Practice Address - Country:US
Practice Address - Phone:024-903-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist