Individual
MR. JON MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
340 BROADWAY # 5, PROVIDENCE, RI 02909-1102
(401) 321-4130
Mailing address
340 BROADWAY # 5, PROVIDENCE, RI 02909-1102
(401) 321-4130
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT01438
RI
Other
Enumeration date
06/27/2023
Last updated
08/03/2023
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