Provider Demographics
NPI:1831819309
Name:COUSIN, JONATHAN ESTEBAN (PT, DPT, MSBH)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ESTEBAN
Last Name:COUSIN
Suffix:
Gender:M
Credentials:PT, DPT, MSBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2235
Mailing Address - Country:US
Mailing Address - Phone:661-345-8874
Mailing Address - Fax:
Practice Address - Street 1:433 SOSCOL AVE STE B191
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4040
Practice Address - Country:US
Practice Address - Phone:707-224-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist