Provider Demographics
NPI:1417361023
Name:JONES, NICHOLAS (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 HALEY GLENN LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-9602
Mailing Address - Country:US
Mailing Address - Phone:901-834-5895
Mailing Address - Fax:
Practice Address - Street 1:1726 HALEY GLENN LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-9602
Practice Address - Country:US
Practice Address - Phone:901-834-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007023Medicaid
TN0677340005Medicare NSC
TN103I654189Medicare PIN
0677340003Medicare NSC
TNQ007023Medicaid
TN103I654172Medicare PIN
TN0677340001Medicare NSC