Healthcare Provider Details

I. General information

NPI: 1205147352
Provider Name (Legal Business Name): JONATHAN G. TUMA MMT, CKTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MARJORIE ST
MYSTIC CT
06355-3626
US

IV. Provider business mailing address

22 MARJORIE ST
MYSTIC CT
06355-3626
US

V. Phone/Fax

Practice location:
  • Phone: 860-326-6034
  • Fax:
Mailing address:
  • Phone: 860-326-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberXXXXXX
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberXXXXXX
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA79049
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number004158
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT01411
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: