Provider Demographics
NPI:1407512098
Name:JONES, DESTINEY RAE
Entity Type:Individual
Prefix:MS
First Name:DESTINEY
Middle Name:RAE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 WALZEM RD STE A
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2171
Mailing Address - Country:US
Mailing Address - Phone:210-621-7024
Mailing Address - Fax:
Practice Address - Street 1:5313 WALZEM RD STE A
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2171
Practice Address - Country:US
Practice Address - Phone:210-798-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMP135594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist