MEDICARE: JONATHAN DUNAGAN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT-24147	AZ

General Provider Information

NPI Number	:	1316564735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DUNAGAN LMT

Provider Business Mailing Address
First Line	:	7716 E THELMA DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-7001
Country	:	US
Telephone Number	:	928-458-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 E JACQUE DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-6172
Country	:	US
Telephone Number	:	928-277-8715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	07/01/2020

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