Provider Demographics
NPI:1952733040
Name:REDHOUSE, JONATHAN MARK (CRT RRT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARK
Last Name:REDHOUSE
Suffix:
Gender:M
Credentials:CRT RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 E MONTE VISTA DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2057
Mailing Address - Country:US
Mailing Address - Phone:520-780-8578
Mailing Address - Fax:
Practice Address - Street 1:3627 E. MONTE VISTA UNIT D
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-780-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011004227800000X, 227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified