Provider Demographics
NPI:1760222962
Name:REDMOND, JOHNATHON
Entity type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:
Last Name:REDMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 SONIA TRL APT 105
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3701
Mailing Address - Country:US
Mailing Address - Phone:240-375-2946
Mailing Address - Fax:
Practice Address - Street 1:1202 ANNAPOLIS RD STE E
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1398
Practice Address - Country:US
Practice Address - Phone:410-417-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist