Provider Demographics
NPI:1144585860
Name:PRINCE, JON W (DPT)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:W
Last Name:PRINCE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:940 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4309
Mailing Address - Country:US
Mailing Address - Phone:806-358-7474
Mailing Address - Fax:806-358-7575
Practice Address - Street 1:7726 WHITE PLAINS AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1774
Practice Address - Country:US
Practice Address - Phone:806-353-6544
Practice Address - Fax:806-355-1587
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist