Active NPI
Jonathan Kotredes, ATC
- Athletic Trainer
- Washington, DC
National Provider Identifier
1235915570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL4359
- Practice address
- 1500 S Capitol St SE
Washington, DC 20003-3599 - Phone
- (202) 302-9255
- NPI assigned
- Sep 4, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL4359 | FL | Primary |
Addresses
Primary practice location
1500 S Capitol St SE
Washington, DC 20003-3599
Mailing address
6393 Branchwood Dr
Lake Worth, FL 33467-7378
Phone (207) 951-1702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL4359 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693785600000",
"number": "1235915570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6393 BRANCHWOOD DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334677378",
"telephone_number": "207-951-1702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S CAPITOL ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200033599",
"telephone_number": "202-302-9255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTREDES",
"first_name": "JONATHAN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-04",
"last_updated": "2023-09-04",
"certification_date": "2023-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL4359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.