Provider Demographics
NPI:1609205475
Name:LARGENT, JONATHAN (LMP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LARGENT
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 1:23319 CEDAR WAY
Mailing Address - Street 2:APT #K201
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4991
Mailing Address - Country:US
Mailing Address - Phone:801-419-2450
Mailing Address - Fax:
Practice Address - Street 1:14862 LAKE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5821
Practice Address - Country:US
Practice Address - Phone:425-649-9335
Practice Address - Fax:425-649-0256
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60342187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist