Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | XXXXXX | CT |
N | 225400000X | Rehabilitation Practitioner | ||
Y | 225700000X | Massage Therapist | 004158 | CT |
N | 225700000X | Massage Therapist | MA79049 | FL |
N | 225700000X | Massage Therapist | MT01411 | RI |
NPI | 1205147352 |
---|---|
Provider Name | Jonathan G. Tuma |
First Address | Mystic, CT 06355-3626 |
Second Address | Mystic, CT 06355-3626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 08/10/2019 |