Provider Demographics
NPI:1356577621
Name:GAGE, JONATHAN LEE (LMP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LEE
Last Name:GAGE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3079
Mailing Address - Country:US
Mailing Address - Phone:509-884-4357
Mailing Address - Fax:
Practice Address - Street 1:739 S MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3079
Practice Address - Country:US
Practice Address - Phone:509-884-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60041531172M00000X
WANA60043977376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No376K00000XNursing Service Related ProvidersNurse's Aide