Basic Information
| Provider Information | |||||||||
| NPI: | 1023095890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | MEAD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 COMMONWEALTH AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022151605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173583700 | ||||||||
| FaxNumber: | 6173583710 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 COMMONWEALTH AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022151605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173583700 | ||||||||
| FaxNumber: | 6173583710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 03/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16650 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.