Provider Demographics
NPI:1023153392
Name:JOVE, JONATHAN P (MPT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:P
Last Name:JOVE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LIMITED LN NW STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2704
Mailing Address - Country:US
Mailing Address - Phone:253-350-1869
Mailing Address - Fax:
Practice Address - Street 1:3000 LIMITED LN NW STE 100
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2704
Practice Address - Country:US
Practice Address - Phone:253-350-1869
Practice Address - Fax:360-292-7247
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1463799OtherTAX ID
WA8384067Medicaid
WA0180964OtherDEPT. OF L&I
WA1725JOOtherREGENCE
WA8384067Medicaid