Provider Demographics
NPI:1033284674
Name:JONES-IRVIN, PAULA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:A
Last Name:JONES-IRVIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LOS PECOS TRL
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7893
Mailing Address - Country:US
Mailing Address - Phone:505-281-3369
Mailing Address - Fax:
Practice Address - Street 1:3 GEORGE CT
Practice Address - Street 2:SUITE A
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9106
Practice Address - Country:US
Practice Address - Phone:505-281-8463
Practice Address - Fax:505-281-8469
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM08028079Medicaid
NM41385268Medicaid