Provider Demographics
NPI:1003029976
Name:JONES, PENELOPE (MPT)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 DIXIE HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2092
Mailing Address - Country:US
Mailing Address - Phone:248-380-8300
Mailing Address - Fax:248-384-8301
Practice Address - Street 1:6815 DIXIE HWY STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2092
Practice Address - Country:US
Practice Address - Phone:248-380-8300
Practice Address - Fax:248-384-8301
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501006617OtherLICENSE NUMBER