Provider Demographics
NPI:1760931075
Name:MARINO, JONATHON
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 BRADWELL LN APT B
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-3293
Mailing Address - Country:US
Mailing Address - Phone:847-858-6963
Mailing Address - Fax:
Practice Address - Street 1:1248 BRADWELL LN APT B
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3293
Practice Address - Country:US
Practice Address - Phone:847-858-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer