Provider Demographics
NPI:1629778311
Name:VALENTINE, JONATHAN XAVIER (LMT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:XAVIER
Last Name:VALENTINE
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 1:4324 MAPLESHADE LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-0044
Mailing Address - Country:US
Mailing Address - Phone:469-415-4420
Mailing Address - Fax:
Practice Address - Street 1:4324 MAPLESHADE LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-0044
Practice Address - Country:US
Practice Address - Phone:469-415-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist