Provider Demographics
NPI:1295814549
Name:JONES, KENNETH JOHN (PTA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:JONES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST
Mailing Address - Street 2:360
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3581
Mailing Address - Country:US
Mailing Address - Phone:413-734-8440
Mailing Address - Fax:413-731-6703
Practice Address - Street 1:300 STAFFORD ST
Practice Address - Street 2:SUITE 360
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3581
Practice Address - Country:US
Practice Address - Phone:413-734-8440
Practice Address - Fax:413-731-6703
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7627225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant