Provider Demographics
NPI:1003670837
Name:JONES, LIDIYANA PLES (PTA)
Entity Type:Individual
Prefix:
First Name:LIDIYANA
Middle Name:PLES
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 BRICKYARD BLVD APT 4071
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1654
Mailing Address - Country:US
Mailing Address - Phone:724-970-5150
Mailing Address - Fax:
Practice Address - Street 1:12158 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1932
Practice Address - Country:US
Practice Address - Phone:301-390-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5667225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant