Provider Demographics
NPI:1417021262
Name:DENTON, JONATHAN (LMT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DENTON
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 1:18121 SE RIVER RD # 14-14
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-6021
Mailing Address - Country:US
Mailing Address - Phone:503-781-2494
Mailing Address - Fax:
Practice Address - Street 1:7052 SW NYBERG ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9231
Practice Address - Country:US
Practice Address - Phone:503-766-3366
Practice Address - Fax:503-766-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist