Jonathan Gage Beaber, ATC
Individual provider Active NPI Athletic Trainer · Sylvania, OH
NPI 1083095103 · NPPES record last updated May 29, 2025
Key facts
- NPI
- 1083095103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 7640 Sylvania Ave Ste E
Sylvania, OH 43560-9263 - Phone
- (419) 251-2061
- NPI assigned
- Jun 15, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
7640 Sylvania Ave Ste E
Sylvania, OH 43560-9263
Mailing address
403 Superior St
Genoa, OH 43430-1733
Phone (419) 307-7706
Other providers in Sylvania, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.