Provider Demographics
NPI:1205147352
Name:TUMA, JONATHAN G (MMT, CKTP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:G
Last Name:TUMA
Suffix:
Gender:M
Credentials:MMT, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MARJORIE ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-3626
Mailing Address - Country:US
Mailing Address - Phone:860-326-6034
Mailing Address - Fax:
Practice Address - Street 1:22 MARJORIE ST
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3626
Practice Address - Country:US
Practice Address - Phone:860-326-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79049225700000X
CT004158225700000X
CTXXXXXX208VP0014X, 2081P2900X
225400000X
RIMT01411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner