Provider Demographics
NPI:1346637592
Name:FINK, JONATHAN M (LMP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:FINK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:EAST OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98540-0661
Mailing Address - Country:US
Mailing Address - Phone:360-623-9307
Mailing Address - Fax:
Practice Address - Street 1:2330 MOTTMAN RD SW # 106
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6232
Practice Address - Country:US
Practice Address - Phone:360-623-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60549787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist