Provider Demographics
NPI:1962767392
Name:HODAPP, JONATHAN CHARLES (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CHARLES
Last Name:HODAPP
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 1:3030 SW EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3202
Mailing Address - Country:US
Mailing Address - Phone:772-284-4111
Mailing Address - Fax:
Practice Address - Street 1:3030 SW EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3202
Practice Address - Country:US
Practice Address - Phone:772-284-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 33082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer