Provider Demographics
NPI:1235287616
Name:JONES, RICKARD L (MSPT)
Entity Type:Individual
Prefix:
First Name:RICKARD
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-4136
Mailing Address - Country:US
Mailing Address - Phone:503-357-7822
Mailing Address - Fax:503-357-1472
Practice Address - Street 1:2726 19TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2623
Practice Address - Country:US
Practice Address - Phone:503-357-7822
Practice Address - Fax:503-357-1472
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR295470Medicaid
OR295470Medicaid