Provider Demographics
NPI:1194194464
Name:JONES, MYRA O (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:O
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 1:1712 ALCALA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-3413
Mailing Address - Country:US
Mailing Address - Phone:805-453-3969
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 588, M/C 7002
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-893-3193
Practice Address - Fax:805-893-4887
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10908225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant