Provider Demographics
NPI:1386230431
Name:STONE, JONATHAN (PTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:STONE
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 1:280 MT HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36025-1526
Mailing Address - Country:US
Mailing Address - Phone:334-567-8484
Mailing Address - Fax:
Practice Address - Street 1:280 MT HEBRON RD
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:AL
Practice Address - Zip Code:36025-1526
Practice Address - Country:US
Practice Address - Phone:334-567-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA5617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant