Provider Demographics
NPI:1093168197
Name:JONES-JENNINGS, IVORY KEONA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:IVORY
Middle Name:KEONA
Last Name:JONES-JENNINGS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 FLAMINGO DR
Mailing Address - Street 2:#3312
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-7001
Mailing Address - Country:US
Mailing Address - Phone:904-536-7262
Mailing Address - Fax:
Practice Address - Street 1:5232 MOON SHELL DR
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3522
Practice Address - Country:US
Practice Address - Phone:904-536-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist