Provider Demographics
NPI:1316661127
Name:POMATTO, JONATHAN ANTHONY
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANTHONY
Last Name:POMATTO
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 1:28880 W 335TH ST
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-4198
Mailing Address - Country:US
Mailing Address - Phone:913-731-7432
Mailing Address - Fax:
Practice Address - Street 1:28880 W 335TH ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-4198
Practice Address - Country:US
Practice Address - Phone:913-731-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer