Healthcare Provider Details

I. General information

NPI: 1629984182
Provider Name (Legal Business Name): JONATHAN NATEGHI-ASLI CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 SUNDROP LN
LITTLE RIVER SC
29566-5935
US

IV. Provider business mailing address

5009 SUNDROP LN
LITTLE RIVER SC
29566-5935
US

V. Phone/Fax

Practice location:
  • Phone: 703-229-7367
  • Fax:
Mailing address:
  • Phone: 703-229-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14400
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: