Provider Demographics
NPI:1093092934
Name:JONES, JESSE TYLER (LMT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:TYLER
Last Name:JONES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4484
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-0048
Mailing Address - Country:US
Mailing Address - Phone:202-413-6999
Mailing Address - Fax:
Practice Address - Street 1:1902 120TH PL SE STE 103B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-8400
Practice Address - Country:US
Practice Address - Phone:202-413-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist