Provider Demographics
NPI:1093040826
Name:THEUS, JONESLY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JONESLY
Middle Name:
Last Name:THEUS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22104 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2300
Mailing Address - Country:US
Mailing Address - Phone:917-535-3136
Mailing Address - Fax:
Practice Address - Street 1:22104 137TH AVE
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2300
Practice Address - Country:US
Practice Address - Phone:917-535-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist