Provider Demographics
NPI:1174005730
Name:JONES, TERESA DIANE (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANE
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 S ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-5149
Mailing Address - Country:US
Mailing Address - Phone:806-894-2806
Mailing Address - Fax:806-894-1898
Practice Address - Street 1:803 S ALAMO RD
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-5149
Practice Address - Country:US
Practice Address - Phone:806-894-2806
Practice Address - Fax:806-894-1898
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2043461225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant