Provider Demographics
NPI:1043558505
Name:JONES, SAGE CODY
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:CODY
Last Name:JONES
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 1:990 E CALVADA BLVD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5603
Mailing Address - Country:US
Mailing Address - Phone:775-751-5211
Mailing Address - Fax:775-751-6176
Practice Address - Street 1:990 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5603
Practice Address - Country:US
Practice Address - Phone:775-751-5211
Practice Address - Fax:775-751-6176
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner