Provider Demographics
NPI:1427018241
Name:JONES, NICOLE ALEXANDRA (MPT, MTC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXANDRA
Last Name:JONES
Suffix:
Gender:F
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALEXANDRA
Other - Last Name:BIBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2569 152ND AVE NE
Mailing Address - Street 2:BLDG 15, UNIT C
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-497-8180
Mailing Address - Fax:425-881-3585
Practice Address - Street 1:2569 152ND AVE NE
Practice Address - Street 2:BLDG 15, UNIT C
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-497-8180
Practice Address - Fax:425-881-3585
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8396186Medicaid
WA8396186Medicaid