Provider Demographics
NPI:1689145039
Name:BUFFINGTON, JONATHON PETER (LMT)
Entity Type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:PETER
Last Name:BUFFINGTON
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 1:25 E FAIRVIEW AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4931
Mailing Address - Country:US
Mailing Address - Phone:208-949-9491
Mailing Address - Fax:
Practice Address - Street 1:25 E FAIRVIEW AVE STE 112
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4931
Practice Address - Country:US
Practice Address - Phone:208-949-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist