Provider Demographics
NPI:1225262389
Name:BARRETT, JONATHON M (LMT)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:M
Last Name:BARRETT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3952
Mailing Address - Country:US
Mailing Address - Phone:937-217-7127
Mailing Address - Fax:
Practice Address - Street 1:4720 MOORE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3952
Practice Address - Country:US
Practice Address - Phone:937-217-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16986171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor