Provider Demographics
NPI:1114350162
Name:JONES, AUTUMN C (PT)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:C
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:C
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2969
Mailing Address - Country:US
Mailing Address - Phone:636-219-9204
Mailing Address - Fax:
Practice Address - Street 1:550 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2969
Practice Address - Country:US
Practice Address - Phone:636-219-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist