Provider Demographics
NPI:1760794234
Name:COUTINHO, JONATHAN MARK (MMP, LMT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARK
Last Name:COUTINHO
Suffix:
Gender:M
Credentials:MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 PAVILION CT
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-9016
Mailing Address - Country:US
Mailing Address - Phone:979-661-1510
Mailing Address - Fax:
Practice Address - Street 1:12514 PAVILION CT
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-9016
Practice Address - Country:US
Practice Address - Phone:979-661-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist