Provider Demographics
NPI:1063853646
Name:JONES, EDWARD RAYMOND JR (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:RAYMOND
Last Name:JONES
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ED
Other - Middle Name:R
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT, OCS
Mailing Address - Street 1:3000 S STATE ROAD 135 STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9607
Mailing Address - Country:US
Mailing Address - Phone:317-535-4075
Mailing Address - Fax:317-535-4076
Practice Address - Street 1:3000 S STATE ROAD 135 STE 110
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9607
Practice Address - Country:US
Practice Address - Phone:317-535-4075
Practice Address - Fax:317-535-4076
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008313A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic