Provider Demographics
NPI:1861927899
Name:KITTS, JOHNATHAN (ATC)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:KITTS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 EMILY LN APT 4107
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6629
Mailing Address - Country:US
Mailing Address - Phone:704-652-8076
Mailing Address - Fax:
Practice Address - Street 1:316 BOULEVARD
Practice Address - Street 2:BOX 999
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4002
Practice Address - Country:US
Practice Address - Phone:864-231-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer