Provider Demographics
NPI:1114273562
Name:JONES, JANET L (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2471
Mailing Address - Country:US
Mailing Address - Phone:706-769-0366
Mailing Address - Fax:
Practice Address - Street 1:264 CONCORD DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2471
Practice Address - Country:US
Practice Address - Phone:706-769-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20-0853545OtherEIN NUMBER ISSUED FOR COMPANY BY THE STATE OF GEORGIA