Provider Demographics
NPI:1396347563
Name:JARVIS, RONALD SCOTT
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:JARVIS
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 1:24116 62ND WAY S APT 16-103
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4690
Mailing Address - Country:US
Mailing Address - Phone:406-314-5812
Mailing Address - Fax:
Practice Address - Street 1:24116 62ND WAY S APT 16-103
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4690
Practice Address - Country:US
Practice Address - Phone:406-314-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61106067225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist