Provider Demographics
NPI:1073762134
Name:JONES, MARY (MPT)
Entity Type:Individual
Prefix:MS
First Name:MARY
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 1:2166 YELLOW LEAF CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6278
Mailing Address - Country:US
Mailing Address - Phone:907-455-6875
Mailing Address - Fax:
Practice Address - Street 1:2166 YELLOW LEAF CT
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-6278
Practice Address - Country:US
Practice Address - Phone:907-455-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-14
Last Update Date:2008-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist