Provider Demographics
NPI:1104595453
Name:MARSHALL, JONATHAN DAVID (LMT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1734
Mailing Address - Country:US
Mailing Address - Phone:202-567-7533
Mailing Address - Fax:202-217-4226
Practice Address - Street 1:2714 2ND ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1734
Practice Address - Country:US
Practice Address - Phone:202-567-7533
Practice Address - Fax:202-217-4226
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist