Provider Demographics
NPI:1700955655
Name:HARKER, JONATHAN (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HARKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ALPOWA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-9759
Mailing Address - Country:US
Mailing Address - Phone:909-354-1801
Mailing Address - Fax:
Practice Address - Street 1:718 MAIN STREET
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347-0967
Practice Address - Country:US
Practice Address - Phone:509-843-2356
Practice Address - Fax:509-843-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA501301Medicare ID - Type Unspecified