Healthcare Provider Details

I. General information

NPI: 1457015117
Provider Name (Legal Business Name): JONATHAN WAYNE PETE RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

30919 SHADY OAK DR
FULSHEAR TX
77441-1609
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 713-585-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRCP00066711
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: